Can sutures be performed days after an injury?

From the Guidelines

Sutures can be done days after an injury, but the decision to do so should be based on the wound's cleanliness, location, size, and signs of infection, with consideration of delayed primary closure after 3-5 days of cleaning and monitoring, as recommended by the most recent guidelines 1.

Key Considerations

• The timing of suturing depends on various factors, including the type of wound, its location, and the presence of infection.
• Delayed primary closure may be considered for contaminated or dirty wounds after 3-5 days of cleaning and monitoring, as suggested by the 2023 World Society of Emergency Surgery guidelines 1.
• The decision to suture an older wound should be made on a case-by-case basis, taking into account the wound's appearance, size, and signs of infection.

Evidence-Based Recommendations

• The 2023 World Society of Emergency Surgery guidelines recommend considering delayed primary closure of surgical wounds compared to primary closure in case of contaminated and dirty incisions with purulent contamination (2B) 1.
• The guidelines also suggest that when delayed closure of surgical incision is performed, a revision should be done between two and five days postoperatively (1B) 1.
• A systematic review and meta-analysis published in 2020 found that delayed primary skin closure may reduce the incidence of surgical site infections (SSI) in contaminated abdominal surgeries, but the evidence was not definitive 1.

Clinical Implications

• Clinicians should carefully evaluate the wound and consider the risks and benefits of suturing before making a decision.
• Delayed primary closure may be a viable option for certain wounds, but it requires careful monitoring and management to minimize the risk of infection.
• The use of negative pressure wound therapy (NPWT) may also be considered as an adjunct to wound management, as recommended by the 2023 AAOS clinical practice guideline summary 1.

From the Research

Suturing After an Injury

• The decision to suture a wound depends on various factors, including the type of wound, its location, skin thickness, wound tension, and cosmetic considerations 2.
• The optimal timing of suture removal depends on the anatomical location of the wound, with recommendations varying from 3-14 days 3.
• Sutures can be used to close wounds days after an injury, but the timing and technique used may affect the risk of surgical site infection (SSI) 4, 5.

Considerations for Suturing

• The type of suture material used can affect the risk of infection and inflammatory reaction associated with the suture material 6.
• Antimicrobial sutures coated with antiseptics such as triclosan and chlorhexidine have been used to minimize the occurrence of SSI, but the emergence of resistant strains may affect their efficacy 5.
• Fibrin sealant can be used as a useful adjunct to sutures to promote optimal wound integrity, or independently to seal wound sites where sutures cannot control bleeding or would aggravate bleeding 6.

Risks and Complications

• SSI can delay wound healing, impair cosmetic outcome, and increase healthcare costs 4.
• The use of topical antibiotics on surgical wounds healing by primary intention probably reduces the risk of SSI, but the relative effects of different topical antibiotics are unclear 4.
• The risk of allergic contact dermatitis and anaphylaxis associated with the use of topical antibiotics or antimicrobial sutures is unclear due to lack of statistical power 4, 5.