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Small Lacerations of the Hand Heal Faster Without Suturing



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Am Fam Physician. 2003 Jan 1;67(1):182-184.

Lacerations of the hand are common. All treatments aim for a functional and cosmetically acceptable scar with minimal morbidity and optimal patient satisfaction. Although traditional sutures provide secure wound closure, they can be painful and require significant resources in time and materials. Quinn and colleagues compared the outcome of suturing with that of conservative treatment for hand lacerations up to 2 cm in length in patients presenting to a tertiary emergency department.

All patients with lacerations 2 cm or smaller were eligible for the trial, except those who presented more than eight hours after injury, had a risk for complications, or had difficulty in hemostasis. Patients with diabetes, bleeding disorders (including those receiving anticoagulants), and prolonged steroid use also were excluded from the study. After irrigation for up to two minutes, patients were randomized to closure with monofilament sutures under local anesthesia followed by antibiotic ointment for 48 hours, or to conservative treatment with only antibiotic ointment and dressing for 48 hours. Both groups of patients received the same advice and written instructions about wound care. Patients rated the discomfort of initial treatment on a visual analog scale and returned after eight to 10 days for assessment and suture removal, if appropriate. At follow-up, wounds were scored on six characteristics (irregularity, separation of wound margin, edge inversion, distortion, “step-off” borders, and overall cosmetic appearance). Patients also reported on function of the injured hand at this visit. Three months after the initial treatment, photographs of the healed wounds were scored by two independent physicians who did not know the treatment provided.

Clinical Outcomes for Suturing vs. Conservative Management of Lacerations

Treatment
Clinical outcome Suture Conservative Mean difference (95% CI)

Cosmetic appearance at 3 months (mm)*:

Assigned by doctor

83.0 (10.0)

80.0 (11.3)

3 (−1 to 8)

Self-assigned by patients

83.0 (18.1)

82.0 (19.5)

1 (−7 to 9)

Time to resume normal activities (days)

3.4 (3.4)

3.4 (2.9)

0 (−1.4 to 1.3)

Percentage (number) of optimal early wound scores

92.0 (34/37)

89.0 (31/36)

3 (−11 to 17)

Pain during treatment (mm)*

31.0 (16.4)

13.0 (12.0)

18 (12 to 24)

Duration of treatment (minutes)

19.0 (12.8)

5.0 (4.6)

14 (10 to 18)

Number of infections

1.0

0.0


note:Values are means (SD) unless stated otherwise.

CI = confidence interval; SD = standard deviations.

*—Cosmesis and pain were scored on a visual analog scale ranging from zero to 100 mm.

Adapted with permission from Quinn J, Cummings S, Callaham M, Sellers K. Suturing versus conservative management of lacerations of the hand: randomised controlled trial. BMJ 2002;325:300.

Clinical Outcomes for Suturing vs. Conservative Management of Lacerations

View Table

Clinical Outcomes for Suturing vs. Conservative Management of Lacerations

Treatment
Clinical outcome Suture Conservative Mean difference (95% CI)

Cosmetic appearance at 3 months (mm)*:

Assigned by doctor

83.0 (10.0)

80.0 (11.3)

3 (−1 to 8)

Self-assigned by patients

83.0 (18.1)

82.0 (19.5)

1 (−7 to 9)

Time to resume normal activities (days)

3.4 (3.4)

3.4 (2.9)

0 (−1.4 to 1.3)

Percentage (number) of optimal early wound scores

92.0 (34/37)

89.0 (31/36)

3 (−11 to 17)

Pain during treatment (mm)*

31.0 (16.4)

13.0 (12.0)

18 (12 to 24)

Duration of treatment (minutes)

19.0 (12.8)

5.0 (4.6)

14 (10 to 18)

Number of infections

1.0

0.0


note:Values are means (SD) unless stated otherwise.

CI = confidence interval; SD = standard deviations.

*—Cosmesis and pain were scored on a visual analog scale ranging from zero to 100 mm.

Adapted with permission from Quinn J, Cummings S, Callaham M, Sellers K. Suturing versus conservative management of lacerations of the hand: randomised controlled trial. BMJ 2002;325:300.

Complete data and photographs were available for 41 sutured and 40 conservatively treated patients. The two groups of patients were comparable demographically and clinically on entry to the study. Scores for cosmetic appearance at three months, assessment of outcome by patients, and time until normal activities could be resumed were not significantly different in the two treatment groups. Suturing was associated with longer and more painful treatment. Only one wound infection (in the sutured group) was documented during the study (see accompanying table).

The authors conclude that simple, small lacerations of the hand should be treated conservatively because this provides comparable results to suturing with less discomfort and uses fewer resources.

Quinn J, et al. Suturing versus conservative management of lacerations of the hand: randomised controlled trial. BMJ. August 10, 2002;325:299–300.

editor's note: Sometimes we just don't see the entire picture of the condition. As these authors point out, the decision to suture is usually made rapidly, based on experience and “usual practice.” We feel an overwhelming need to do something to help, but healing can proceed quite well on its own. This simple study could lead to enormous savings if operationalized nationally. The authors were honest enough to state “we were impressed with how inconspicuous most scars were after three months and at the high level of patients' satisfaction with the appearance of their wound.”—a.d.w.

 


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