What is the recommended timeline for suturing a laceration of the hand?

Timeline for Suturing Hand Lacerations

Hand lacerations can be safely sutured well beyond the traditional "6-hour golden period," with evidence supporting closure up to 18-24 hours after injury for most wounds, provided they are properly irrigated and debrided. 1

Evidence Against the "Golden Period" Myth

The traditional 6-hour rule for wound closure is based on a 1898 animal experiment and lacks modern clinical validation 2. Contemporary evidence demonstrates:

• No definitive "golden period" exists for safe laceration repair, and depending on wound characteristics, closure may be reasonable even 18+ hours post-injury 1
• Studies consistently show that delays in wound closure rarely cause infection when proper wound preparation is performed 2
• The decision to close should be based on wound characteristics rather than arbitrary time cutoffs 1

Risk Stratification for Delayed Closure

High-risk wounds requiring earlier closure or special consideration:

• Contaminated wounds (dirt, debris, organic matter) - these significantly increase infection risk and imperfect healing rates 3
• Bite wounds (human or animal) - these are controversial for primary closure and may require delayed closure or healing by secondary intention 4
• Wounds with visible foreign bodies - require thorough debridement before closure 5
• Diabetic patients - diabetes is a confirmed risk factor for wound infection with delayed closure 2

Lower-risk wounds suitable for extended closure windows:

• Clean lacerations with minimal contamination can be closed later than traditionally recommended 1
• Facial wounds may be closed primarily even with some delay, given the excellent blood supply 6

Optimal Closure Timing by Clinical Context

For standard hand lacerations:

• Aim for closure within 12-18 hours when possible, but do not refuse closure solely based on time elapsed 1
• Prioritize thorough irrigation with potable tap water or sterile saline under pressure over rushing to meet an arbitrary deadline 1, 5

For contaminated hand wounds:

• Consider delayed primary closure (3-5 days) rather than immediate closure if heavily contaminated 4
• Pack the wound during the delay period if closure is deferred 4

For bite wounds to the hand:

• Primary closure is generally not recommended for hand bite wounds due to higher infection rates in this location 6
• Facial bite wounds are the exception and can be closed primarily with copious irrigation, cautious debridement, and prophylactic antibiotics 6

Critical Pre-Closure Requirements

Before suturing any hand laceration, regardless of timing:

• Irrigate thoroughly with tap water or sterile saline under pressure to remove microscopic infectious agents and debris 1, 5
• Debride superficial debris and devitalized tissue 4
• Assess for deeper injury to bones, tendons, nerves, or vessels - these require specialist referral 7
• Remove foreign bodies - note that not all are visible on plain radiographs 5
• Ensure tetanus prophylaxis is current (booster if >10 years for clean wounds, >5 years for contaminated wounds) 6

Suture Retention Time for Hand Lacerations

Once closed, hand lacerations require 10-14 days of suture retention due to high mobility and tension in this region 8, 9. The thumb webbing specifically benefits from extended duration of 12-14 days 8, 9.

Common Pitfalls to Avoid

• Do not refuse to close a wound solely because it exceeds 6 hours - assess wound characteristics instead 1, 2
• Do not close heavily contaminated wounds without adequate irrigation and debridement - contamination is the most important factor in infection risk 3
• Do not close hand bite wounds primarily - these have higher infection rates than other locations 6
• Do not use locked sutures - they cause excessive tension leading to tissue edema and necrosis 8