Suturing versus conservative management of lacerations of the hand: randomised controlled trial

doi:10.1136/bmj.325.7359.299

BMJ 2002;325:299 ( 10 August )

Papers

Suturing versus conservative management of lacerations of the hand: randomised controlled trial

James Quinn, associate clinical professor, ^a Steven Cummings, professor, ^b Michael Callaham, professor, ^a Karen Sellers, registered nurse. ^a

^a Division of Emergency Medicine, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0208, USA, ^b Department of Medicine, University of California at San Francisco, San Francisco, CA 94118

Correspondence to: J Quinn quinnj{at}medicine.ucsf.edu

Objective: To assess the difference in clinical outcomebetween lacerations of the hand closed with sutures and thosetreatedconservatively.
Design: Randomised controlledtrial.
Setting: Emergency department in a tertiaryhospital.
Participants: Consecutive patients presenting between 16February and 30 November 2000 with uncomplicated lacerations ofthe hand (full thickness <2 cm; without tendon, joint, fracture,or nerve complications) who would normally require sutures. 154patients were eligible, 58 refused, and 5 were missed; 91 patientswith 95 lacerations wereenrolled.
Intervention: Participants were randomised to suturing orconservativetreatment.
Main outcome measures: Primary outcome was cosmetic appearance afterthree months, rated on a previously validated visual analoguescale. Duration of treatment, pain during treatment, patients'assessment of their outcome, and the time for patients to resumenormal activities were alsomeasured.
Results: Participants treated with sutures and thosetreated conservatively did not differ significantly in the assessmentof cosmetic appearance by independent blinded doctors after threemonths: 83 mm v 80 mm, (mean difference 3 (95% confidence interval $-$ 1 to 8) mm) on the visual analogue scale. The mean time to resumenormal activities was the same in both groups (3.4 days). Patientstreated conservatively had less pain (difference 18 (12 to 24)mm) and treatment time was 14 (10 to 18) minshorter.
Conclusion: Similar cosmetic and functional outcomes resultfrom either conservative treatment or suturing of small uncomplicatedlacerations of the hand, but conservative treatment is fasterand lesspainful.

What is already known on this topic
Sutures provide secure and meticulous wound closure, but their placement is not without associated pain, fear, and increased risk of infection

Wounds heal by second intention if treated without sutures and left open

What this study adds
Non-suturing of hand lacerations of <2 cm produced similar cosmetic and functional outcomes to suturing and was faster and less painful

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Rapid Responses:

Read all Rapid Responses

missed injuries- missed opportunities: Umraz Khan
bmj.com, 9 Aug 2002 [Full text]
All hand lacerations need careful evaluation: Shehan Hettiaratchy
bmj.com, 9 Aug 2002 [Full text]
Stitich marks - I can tell the difference: Ludwig TSOI
bmj.com, 10 Aug 2002 [Full text]
Re: missed injuries- missed opportunities: James V. Quinn
bmj.com, 10 Aug 2002 [Full text]
Not Suturing Wounds: ANDREW D LAWSON
bmj.com, 10 Aug 2002 [Full text]
Re: Re: missed injuries- missed opportunities: John R Perry
bmj.com, 11 Aug 2002 [Full text]
Re: Stitich marks - I can tell the difference: James V. Quinn
bmj.com, 11 Aug 2002 [Full text]
What about lower cost?: Ron Law
bmj.com, 11 Aug 2002 [Full text]
Why an I not surprised?: Peter R Bradley
bmj.com, 11 Aug 2002 [Full text]
Stitch in Time?: Dilip Menon
bmj.com, 12 Aug 2002 [Full text]
Patient Knowledge as a confounding factor: Colin D Fraser
bmj.com, 12 Aug 2002 [Full text]
Setting precedents for the treatment of hand lacerations: Jonathon M. Pleat
bmj.com, 12 Aug 2002 [Full text]
Re: Setting precedents for the treatment of hand lacerations: James Quinn
bmj.com, 13 Aug 2002 [Full text]
Re: Patient Knowledge as a confounding factor: James Quinn
bmj.com, 13 Aug 2002 [Full text]
Additional reasoning to support secondary intention healing: Sody A Naimer
bmj.com, 13 Aug 2002 [Full text]
Why am I not convinced?: Adrian Fogarty
bmj.com, 14 Aug 2002 [Full text]
Were any of these wounds really "actively managed"?: Heather A Ellison
bmj.com, 14 Aug 2002 [Full text]
Hand Wounds: Dr David F Cochran
bmj.com, 14 Aug 2002 [Full text]
Re: Why am I not convinced?: James Quinn
bmj.com, 15 Aug 2002 [Full text]
Polymyxin B in wound treatment: Dr JK Anand
bmj.com, 15 Aug 2002 [Full text]
Treating simple small superficial hand wounds: What does the excellent RCT prove?: Dr Ahmed N. Ghanem, MD, FRCS Ed.
bmj.com, 15 Aug 2002 [Full text]
Photograph does the article a great disservice: Martin J Heaton, et al.
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Wounds heal better from gradual regeneration: Stewart F Mitchell
bmj.com, 16 Aug 2002 [Full text]
not all hand lacerations are the same: Tim N Board
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Re: Re: Why am I not convinced?: Adrian Fogarty
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The distinction between lacerations and incised wounds: Matthew M Orde
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Re: Re: Re: Why am I not convinced?: James Quinn
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Incisions are not Lacerations: Alistair J Irvine, et al.
bmj.com, 21 Aug 2002 [Full text]
Re: Re: Re: Re: Why am I not convinced?: Adrian Fogarty
bmj.com, 21 Aug 2002 [Full text]
The Danger of Not Suturing Hand Injuries: MANSOOR S KHAN, et al.
bmj.com, 22 Aug 2002 [Full text]
Hand lacerations should be explored before conservative treatment: Roderick Dunn, et al.
bmj.com, 2 Sep 2002 [Full text]
Suturing versus conservative management of lacerations of the hand: Beryl A. De Souza, et al.
bmj.com, 28 Aug 2002 [Full text]