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Management of Lacerations: The Dogma Is Changing

Summary and Comment |
February 7, 2014

Management of Lacerations: The Dogma Is Changing

  1. Cheryl Lynn Horton, MD

Infection rate was not associated with time to wound closure but was associated with diabetes and certain wound characteristics.

  1. Cheryl Lynn Horton, MD

Optimal laceration management is controversial, and current practice is heavily influenced by studies published in the 1970s. To determine risk factors for wound infection, researchers enrolled 2663 patients with lacerations not caused by bites who were treated at three emergency departments (EDs) during 2008 and 2009. After 30 days, patients were interviewed by phone to determine if an infection had developed, which was defined as having been seen by a physician for a wound infection and treated with antibiotics.

The overall infection rate was 2.6%. Rates did not differ between study sites (a level 1 trauma center, a community nonteaching hospital, and an urban teaching hospital) or with the method of wound repair. Time to wound closure was not associated with infection rates, although more head and neck lacerations presented early (<12 hours) and more extremity and torso lacerations presented late (>12 hours). In multivariate analysis, risk factors for wound infection were diabetes (odds ratio, 3.1), trunk or extremity laceration (OR, 2.5), laceration length >5 cm (OR, 2.4), and wound contamination (OR, 1.9).

Comment

Most lacerations can be closed primarily, and wounds should not be left open or edges loosely approximated solely because of a delay to presentation. Although this is the second large study (NEJM JW Emerg Med Aug 30 2001) to find that diabetes, laceration size, site, and degree of contamination are associated with wound infections, there is no evidence to support the routine use of prophylactic antibiotics. Debridement of devitalized tissue, removal of foreign bodies, and large-volume properly performed irrigation are the most important factors in preventing wound infections.

  • Disclosures for Cheryl Lynn Horton, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (2)

Killam ,Dana Physician, Emergency Medicine, Accident and Urgent Care clinic

The propensity for infection of traumatic wounds are least related to the time interval ,but more to the factors mentioned in the article. As cosmesis is a concern tightly approximated wound margins are often indicated.

Luke Hand MD Physician, Emergency Medicine, Los Angeles, CA

I don't think the term 'tightly' is a good descriptive term to use. Try 'adequately'. Have seen too many so tight the stitches cut thru. the tissue and increased scarring.

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