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Trauma- lacerations

Primary Care Corner with Geoffrey Modest MD: delayed suturing of lacerations not harmful

11 Feb, 14 | by EBM

new article looked at timing to suturing lacerations and outcome (see  doi:10.1136/emermed-2012-202143).  they assessed 2700 consecutive patients after suturing traumatic lacerations, with results:

–69 developed wound infections (not surprisingly these people had less good cosmetic outcome, occ needing scar revision)

–predictors for infection were largely the usual suspects:

–diabetes (RR 2.70)

–contaminated lacerations (RR 2.0)

–lacerations longer than 5 cm (RR 2.9)

–lower extremity lacerations (RR 4.1)

–and, not associated with increased infection rate

–deeper lacerations requiring deep stitches

–suturing after 12 hours vs <12 h, with average times for these groups being 2 vs 16 hours (actually the ones with more delayed closure did better!!). the delayed ones were more likely to be on an extremity. no diff in use of prophylactic antibiotics

so, yet another dogma challenged (i had posted a preliminary report with similar findings, but much smaller study, a couple of years ago). one issue raised in the article is that the above predictors (diabetes, contaminated lac, one longer than 5 cm, lower extrem lac) all  had infection rates in the 5-10% range (actually, the contaminated ones were 4.5%, the rest were higher), and that might be above a threshold to give prophylactic antibiotics.  a thought….

geoff

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