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Practice Uncertainties Page

Should we advise patients with sutures not to swim?

BMJ 2014; 348 doi: (Published 23 May 2014) Cite this as: BMJ 2014;348:g3171
  1. Katherine M Browne, specialist registrar in plastic surgery1,
  2. Olive Murphy, consultant microbiologist2,
  3. A James P Clover, consultant plastic surgeon1
  1. 1Department of Plastic Surgery, Cork University Hospital, Ireland
  2. 2Department of Pathology, Bon Secour Hospital, College Road, Cork, Ireland
  1. Correspondence to: K M Browne
  • Accepted 1 April 2014

Patients often ask when they can swim after a wound has been sutured. Despite such an apparently simple query, evidence supporting any answer seems to be lacking. Many patient information sites advise against swimming after the suturing of wounds1 but fail to provide evidence to support this recommendation. Advice is broad ranging and inconsistent.1 Current information ranges from waiting until the sutures are removed and the wound has healed1 to abstaining from swimming for six weeks postoperatively.2 Patients with external frame fixators are advised that it is permissible to swim in a chlorinated pool or clean sea water, although in practice this is difficult to ascertain and is far from an objective measure, once the pin sites have healed.3 Evidence to back up the advice is scarce.

Concerns about the risks of swimming with a sutured wound primarily centre on the potential for infection,4 5 as opposed to impaired wound healing. The risk of infection depends on the type of wound (for example, an open wound might be said to be at higher risk than an epithelialised wound), comorbidities, the type and quality of water in which patients plan to swim, and the relative risks of complications should the wound become infected. Wound infections can result from exposure to aquatic microbes in treated swimming pools and fresh or marine water.4 5 6 The infective organisms vary accordingly.

It is, however, difficult to quantify the risk of infection in sutured wounds and hence giving an evidence based answer when patients ask about swimming is problematic.

What is the evidence of the uncertainty?

To tackle our dilemma on how to advise patients on swimming with sutures, we searched PubMed, Embase, and Cochrane databases for articles on swimming related wound infections using combinations of the key words “swimming”, “infection”, “wound management”, “water”, “sutures”, …

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