Letters

Suturing v conservative management of hand lacerations

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7372.1113 (Published 09 November 2002) Cite this as: BMJ 2002;325:1113

All lacerations need to be examined thoroughly

  1. Beryl A De Souza, plastic surgery registrar (bds@dr.com),
  2. Mohammed Shibu, consultant plastic surgeon,
  3. Graham Moir, consultant plastic surgeon,
  4. Nigel Carver, consultant plastic surgeon
  1. Department of Plastic Surgery, Barts and the Royal London Trust, Royal London Hospital, London E1 1BB
  2. West of Scotland Regional Plastic Surgery and Burns Unit, Canniesburn Hospital, Glasgow G61 1QL
  3. Medico-Legal Services, Neasless Farm, Sedgefield, Stockton on Tees, Cleveland TS21 3HE
  4. University of California, San Francisco, 505 Parnassus Avenue, Box 0208, San Francisco, CA 94143-0208, USA

    EDITOR—Quinn et al show that conservative treatment is faster and less painful for small uncomplicated lacerations of the hand.1 However, we think that lacerations to the hand, no matter how small, must be examined thoroughly to exclude injuries to tendons, nerves, or joints. The authors make no comment on the mechanism of injury, which is extremely important. A knife stab laceration or glass injury to the hand would make exploration of the wound mandatory. An unimpressive skin wound may hide a remarkable amount of damage to deep structures.2 Similarly, injuries caused by thin slivers of glass produce unimpressive skin wounds but commonly divide flexor tendons and nerves in the forearm.3


    Embedded Image

    To suture or not to suture?

    (Credit: SPL)

    In emergency settings we think that it is crucial to take a good history from the patient about the mechanism of injury and to examine the patient thoroughly before deciding on further management of hand lacerations, albeit suturing or conservative management. In our plastic surgery unit the nurse practitioners who refer cases of hand trauma to us have all been on a hand trauma study day organised by our department. If the mechanism of injury raises any suspicion of a tendon or nerve injury, patients are referred to us and their wounds formally explored in an operating theatre.

    References

    Hand lacerations should be explored before conservative treatment

    1. Roderick Dunn, specialist registrar (roderick.dunn@virgin.net),
    2. Stuart Watson, consultant
    1. Department of Plastic Surgery, Barts and the Royal London Trust, Royal London Hospital, London E1 1BB
    2. West of Scotland Regional Plastic Surgery and Burns Unit, Canniesburn Hospital, Glasgow G61 1QL
    3. Medico-Legal Services, Neasless Farm, Sedgefield, Stockton on Tees, Cleveland TS21 3HE
    4. University of California, San Francisco, 505 Parnassus Avenue, Box 0208, San Francisco, CA 94143-0208, USA

      EDITOR—We are surprised by the publication of the article by Quinn et al on conservative treatment of small …

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