Bmj Usa: Letter

Rapid Responses from bmj.com

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmjusa.02100005 (Published 19 November 2003) Cite this as: BMJ 2003;327:E157

From BMJ USA 2002;October:558

As of September 19, 2002, this article had generated 32 Rapid Responses (http://bmj.com/cgi/eletters/325/7359/299) from which the following edited excerpts are taken.Editor

Setting precedents for the treatment of hand lacerations

  1. Jonathon M Pleat, Duke of Kent Research Fellow in plastic and reconstructive surgery ([email protected])
  1. Stoke Mandeville Hospital, Aylesbury, UK
  2. HKG
  3. Crieff Health Centre, Crieff, UK
  4. Royal Free Hospital, London, UK

    EDITOR—It is not stated who assessed the wounds, but I assume it was the authors. I am sure that they have great experience in hand assessment, but it has been reported that up to 49% of hand and forearm lacerations result in subclinical deep injuries. Even hand surgeons miss 16% of tendon injuries. My major concern is that this study might set a precedent for junior staff to treat all such injuries with minimal deference.

    Although the study quantified the patients' subjective assessment of the pain of treatment, there was no mention of the occasionally disabling symptom of scar tenderness. Theoretically, an unsutured laceration will have a greater tendency to granulation tissue formation, with the possibility of a greater degree of disorganized reinnervation. I note that return to normal activities was similar …

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