Optimal Timeframe for Laceration Repair
Primary closure of most lacerations can be safely performed up to 18-24 hours after injury, and facial lacerations may be closed even later due to their superior blood supply and lower infection risk. 1, 2
Evidence Against the Traditional "Golden Period"
The historical 6-12 hour "golden period" for laceration closure has been largely debunked by modern evidence:
- No significant difference in infection rates exists between lacerations closed before versus after 12 hours (3% vs 1.2% infection rates respectively) 3
- Studies have been unable to define a specific time cutoff beyond which wound infection risk substantially increases 2
- Facial wounds can be closed primarily even when presenting late, provided meticulous wound care and copious irrigation are performed 1
- Modern improvements in irrigation and decontamination techniques over the past 30 years have likely contributed to these improved outcomes 3
Risk Factors That Matter More Than Time
Rather than focusing solely on time to closure, prioritize assessment of these infection risk factors:
High-Risk Patient Factors
- Diabetes increases infection risk 2.7-fold 3
- Immunocompromised status (though specific data limited in general lacerations) 4
High-Risk Wound Characteristics
- Lower extremity location increases infection risk 4.1-fold 3
- Contaminated wounds increase infection risk 2-fold 3
- Laceration length >5 cm increases infection risk 2.9-fold 3
- Gross contamination, bite wounds, or crush injuries 4
Practical Time-Based Algorithm
Facial Lacerations
- Can be closed up to 18+ hours after injury due to excellent blood supply and lower infection risk 1, 2
- Require meticulous wound preparation with copious irrigation 1
- Use betadine or chlorhexidine antiseptic preparation 1
Body and Extremity Lacerations
- Optimal closure within 12-18 hours, though not an absolute cutoff 2, 3
- Lower extremity wounds warrant more caution given 4-fold higher infection risk 3
- Consider delayed closure if presenting with established infection or gross contamination 1
Special Considerations for High-Risk Patients
Diabetic patients:
- Can still undergo primary closure but require heightened vigilance 3
- Consider prophylactic antibiotics only if additional risk factors present (contamination, lower extremity location, length >5 cm) 1, 3
Immunocompromised patients:
- Exercise clinical judgment regarding wound age and contamination level 4
- Lower threshold for delayed closure if multiple risk factors present
Critical Wound Preparation Steps
Regardless of presentation time, proper wound management is essential:
- Remove superficial debris carefully without aggressive debridement that enlarges the wound 1
- Irrigate copiously - tap water is safe and effective 2, 5
- Prepare wound site with betadine or chlorhexidine antiseptic solution 1
When to Avoid Primary Closure
Never close wounds with established infection - these require delayed closure after infection resolution 1
Common Pitfalls to Avoid
- Do not reflexively refuse closure based solely on time elapsed - assess the complete clinical picture including wound characteristics and patient risk factors 2, 3
- Avoid aggressive debridement that enlarges the wound and impairs closure 1
- Do not routinely prescribe prophylactic antibiotics for clean lacerations, even when presenting late - infection rate remains low (approximately 3-5%) 1, 3, 4