Researchers Say the Majority of Hand Cuts Don't Need Stitches

August 09, 2002
News Office: Maureen McInaney (415) 502-6397

Treating small lacerations to the hand with antibiotic ointment and a gauze dressing -- instead of with stitches -- is faster, less painful, and produces similar functional and cosmetic results, according to UCSF Medical Center researchers.

The study, which appears in the Aug. 10, 2002 issue of the British Medical Journal, is the first randomized trial to determine whether the conservative management of uncomplicated, small hand cuts produces similar results to wounds that are traditionally sutured. In this study, patients with these lacerations, less than 2 cm in length, constituted 80 percent of the cases in the emergency department.

"We were impressed with how inconspicuous most scars were three months after suture-free treatment," said Dr. James Quinn, an emergency medicine specialist at UCSF Medical Center and lead author of the study. "In addition, patients had a high level of satisfaction with the appearance of these conservatively treated wounds."

Researchers identified 91 patients who came to the UCSF Medical Center emergency department with uncomplicated lacerations of the hand (less than 2 centimeters in length) that would normally be treated with sutures. Those randomized to suture treatment had their cuts anesthetized and cleaned and the skin closed with monofilament stitches and standard sterile techniques. Those randomized to receive conservative treatment only received tap water irrigation and an antibiotic ointment and gauze dressing applied for 48 hours.

Patients were asked to return in eight to 10 days for sutures to be removed or wounds to be assessed. Patients also rated the pain of their treatment using a standard pain rating scale.

The average time to resume normal activities was the same for both groups. Patients treated conservatively reported less pain, and treatment time was 14 minutes shorter. There was no difference in cosmetic appearance between the suture group and the conservative treatment group after three months, according to the researchers.

All lacerations were deemed to require sutures before randomization. The lacerations treated with sutures in the study required on average 3.5 sutures to achieve wound closure.

Patients were excluded from the study if:

  • Their cuts were larger than 2 centimeters
  • They came to the emergency department more than eight hours after the time of their injury
  • Bleeding could not be stopped after 15 minutes of direct pressure
  • Cuts were associated with neurovascular, tendon or bone injury
  • The cut involved a nail bed
  • The injury was a puncture wound or a cut secondary to a bite wound

The study authors do not dispute that large wounds need to be closed with sutures after meticulous wound care, and they emphasize that their results cannot be generalized to cosmetically sensitive areas such as the face.

Additional investigators on this study include: Dr. Steven Cummings, Dr. Michael Callaham and nurse Karen Sellers, all in the UCSF Medical Center department of emergency medicine.

This study was funded by the National Institutes of Health through the National Institute of Arthritis, Musculoskeletal and Skin Diseases.

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