What are the discharge instructions for a patient with a history of diabetes or anticoagulant therapy who has undergone laceration repair using sutures?

Discharge Instructions for Laceration Repair with Sutures in Patients with Diabetes or on Anticoagulants

Patients with diabetes or on anticoagulant therapy require enhanced wound monitoring and meticulous follow-up after laceration repair, as they face elevated risks of infection, delayed healing, and bleeding complications that demand specific preventive measures and early intervention strategies.

Wound Care Instructions

Keep the Wound Clean and Protected

• Apply a moist occlusive or semiocclusive dressing immediately after repair, as wounds heal faster in a moist environment 1
• Change dressings daily or when they become wet or soiled 1
• After 24-48 hours, you may gently cleanse the wound with clean tap water during showering 1
• Pat the area dry with a clean towel and reapply a clean dressing 2
• Avoid submerging the wound in bathtubs, pools, or hot tubs until sutures are removed 2

Monitor for Infection—Critical in Diabetic Patients

Patients with diabetes have significantly higher infection rates and must check their wound at least twice daily 3. Look for these warning signs:

• Increasing redness spreading beyond 2 cm from the wound edges 3
• Warmth, swelling, or tenderness that worsens after the first 48 hours 3
• Purulent (pus-like) drainage or foul odor 3
• Fever, chills, or feeling systemically unwell 3
• Worsening blood sugar control, which may be the only sign of serious infection in diabetic patients 3

Seek immediate medical attention if any of these signs develop, as diabetic foot infections can progress rapidly and may require hospitalization 3.

Special Considerations for Anticoagulated Patients

Bleeding Precautions

• A pressure dressing should remain in place for 12-24 hours after repair to prevent hematoma formation 4, 5
• After removing the initial pressure dressing, monitor for signs of bleeding or expanding hematoma (swelling, bruising, or blood soaking through the dressing) 4
• Avoid activities that could traumatize the wound or increase bleeding risk for the first 48-72 hours 4
• Do not restart low-molecular-weight heparin in the immediate postoperative period if it was held, as this significantly increases hematoma risk 4

Anticoagulation Management

• Continue your prescribed antiplatelet therapy (aspirin, clopidogrel) as directed—do not stop these medications unless specifically instructed by your physician 4
• If you are on warfarin or direct oral anticoagulants, follow your prescriber's specific instructions about resuming these medications 4

Diabetes-Specific Instructions

Blood Sugar Control

• Maintain tight glycemic control with target blood glucose <180 mg/dL, as elevated glucose levels significantly increase infection risk and impair wound healing 3
• Check your blood sugar more frequently during the healing period, as infection can cause unexplained hyperglycemia 3
• Contact your diabetes care provider if blood sugars are consistently elevated above your target range 3

Wound Inspection Protocol

• Inspect the wound twice daily using good lighting and a mirror if needed to visualize all areas 3
• If you have neuropathy and cannot feel the wound area, visual inspection becomes even more critical 3
• Have a family member or caregiver help with inspection if you have visual impairment or difficulty accessing the wound site 3

Pain Management

• Take acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) as directed for pain control 3
• Apply ice packs wrapped in a towel for 15-20 minutes every 2-3 hours during the first 48 hours to reduce swelling and discomfort 1
• Avoid opioid pain medications if possible, as they can cause constipation and other complications 3
• Some pain is normal for the first 2-3 days, but increasing pain after this period may indicate infection 3

Activity Restrictions

• Avoid strenuous activity, heavy lifting, or movements that place tension on the wound until sutures are removed 6
• For lacerations near joints, minimize movement of that joint for the first 3-5 days 6
• A splint or sling may be necessary for extensive lacerations or those near joints to prevent wound dehiscence 6
• Elevate the affected area above heart level when possible during the first 48 hours to reduce swelling 1

Suture Removal Timing

The timing depends on wound location 1:

• Face and neck: 3-5 days
• Scalp: 7-10 days
• Trunk and upper extremities: 7-10 days
• Lower extremities: 10-14 days
• Joints: 10-14 days

For diabetic patients, consider leaving sutures in place 1-2 days longer than standard timing due to slower healing rates 3.

Follow-Up Appointments

• Return for wound check in 2-3 days (or sooner if signs of infection develop) 3
• Schedule suture removal appointment at the appropriate time based on wound location 1
• For diabetic patients, follow-up within 1-2 weeks after suture removal is recommended to ensure complete healing 3
• Keep all scheduled appointments, as missed follow-up increases complication risk 3

Tetanus Immunization

• Tetanus prophylaxis should have been provided at the time of repair if indicated 7, 1
• If you are unsure of your tetanus status or did not receive a booster, contact your healthcare provider 7

When to Seek Immediate Care

Go to the emergency department or call your doctor immediately if you experience 3:

• Signs of infection as described above
• Wound edges separating or opening
• Significant bleeding that does not stop with 10 minutes of direct pressure
• Numbness or tingling beyond the immediate wound area
• Inability to move the affected area normally
• Red streaks extending from the wound
• Fever >100.4°F (38°C)
• Severe or worsening pain not controlled by prescribed medications

Common Pitfalls to Avoid

• Do not apply hydrogen peroxide, alcohol, or iodine directly to the wound, as these can damage healing tissue 1
• Do not remove the dressing in the first 24 hours unless instructed, especially if you are anticoagulated 4, 5
• Do not ignore subtle signs of infection in diabetes—even minimal redness or drainage warrants evaluation 3
• Do not assume the wound is healing well without direct visualization—always inspect the wound regularly 3