From the Guidelines
Suturing of a laceration is generally appropriate within 8 hours after injury, as recommended by the practice guidelines for the diagnosis and management of skin and soft-tissue infections 1.
Key Considerations
- The decision to suture should consider the wound's location, degree of contamination, and the patient's overall health status.
- Wounds on the face seem to be an exception and can be closed primarily if seen by a plastic surgeon, provided there has been meticulous wound care, copious irrigation, and administration of prophylactic antibiotics 1.
- Infected wounds should not be closed, and approximation of the margins by Steri-Strips and subsequent closure by either delayed primary or secondary intent seem prudent 1.
Important Factors
- The risk of infection increases significantly as bacteria multiply within the wound, making primary closure beyond 8 hours typically not recommended.
- Thorough cleaning, irrigation, and debridement become even more critical before attempting closure, especially for heavily contaminated wounds or those at high risk of infection.
- Tetanus prophylaxis status should be current, and rabies prophylaxis should be considered for all feral and wild animal bites 1.
From the Research
Suturing After Lac Injury
- The maximum number of hours after a lac injury that suturing is appropriate is not strictly defined, as studies have been unable to define a "golden period" for safe wound repair without increasing the risk of infection 2.
- Depending on the type of wound, it may be reasonable to close a wound even 18 or more hours after injury 2.
- The decision to suture a wound should be based on the individual case, taking into account factors such as the type and severity of the wound, the presence of contamination or devitalized tissue, and the overall health of the patient.
- Delayed wound closure may be used in contaminated or devitalized wounds, where the wound is left open for 3-4 days for observation and potential surgical debridement before repair 3.
Factors Affecting Suturing
- The use of nonsterile gloves during laceration repair does not increase the risk of wound infection compared to sterile gloves 2.
- Irrigation with potable tap water rather than sterile saline also does not increase the risk of wound infection 2, 4.
- Local anesthetic with epinephrine in a concentration of up to 1:100,000 is safe for use on digits, and 1:200,000 is safe for use on the nose and ears 2.
- Tissue adhesives and wound adhesive strips can be used effectively in low-tension skin areas 2, 4.