Suture & "Scenario" Question

[mikie]

Obviously this isn't something we'd be do in the field (speaking broadly, that is (I'm sure there are some system that allows it)), but thought I'd ask anyway since we do have some bright & experienced people around..

Is there a "window of time" for sutures?

Scenario: (we'll say this is a hypothetical, since I am in NO WAY SEEKING medical assistance, honoring the forum's rules), lets say I cut my hand last night with a serrated knife, lac. still open (1-3mm deep, 1" long; in between pointer and thumb).

I asked a medic (who's also a pt. tech at an ED) if it needed a sutures and they said no cause there is a window of time to which sutures (at least for this particular wound) have a ~7 hour window (since the wound occurred so many hours ago) for sutures.



So broadly...is there such a 'thing' as a window of time for open lacerations for suturing?

 

[Aidey]

There is a window, it depends on the dimensions and location of the wound, the doc etc. Most commonly I have heard 6-12 hours.

 

[usafmedic45]

Is there a "window of time" for sutures?

Yes, but the "window" depends on where the wound is at and the nature of it (clean vs. dirty vs. filthy). The general rule is if there is any question of whether a wound is contaminated you don't close it primarily (right away) and you simply wait a couple of days to make sure it is not infected and then close it as appropriate. This is called "delayed" or "secondary" closure.

 

[mycrofft]

As long as the wound meets certain parameters:

1. Nothing in it to interfere with hissence such as foreign objects, dried tissue, granular tissue, various first aid creams, etc.
2. The tissue is vital, not ragged, not rotting, and strong enough to hold the sutures or clsoure tape or glue..
3. Mechanically it can be approximated with not much if any tension.

If it is a nice incision (like broken glass or a razor blade), it is cleaned and kept moist with isotonic solution, and local swelling is controlled (ice, elevation and compression), it can be delayed a few hours. After that, it has to be debrided, then the wound bed and edges inspected.

In the field, although actual deep wound closure is often not appropriate, the application of closure type devices to shallow but pesky and cleaned wounds (i.e., fingertip lacs) can speed healing and help prevent infection.

 

[Smash]

Long time, no see. Welcome back mycrofft!

 

[mikie]

thoughts from our fellow Dr (to be)...Vene?

 

[Veneficus]

Yes, but the "window" depends on where the wound is at and the nature of it (clean vs. dirty vs. filthy). The general rule is if there is any question of whether a wound is contaminated you don't close it primarily (right away) and you simply wait a couple of days to make sure it is not infected and then close it as appropriate. This is called "delayed" or "secondary" closure.

Technical error correction.

Delayed wound closure is tertiary wound closure.

secondary is no active attempt at closure and letting the wound heal by epithelialization.



The rest was covered very well by everyone else.

From the acute standpoint, a wound which is "new" defined as roughly 6-8 hours, give or take some variables like age, location, nutritional status etc, can be closed without any special attention.

Past that, a surgeon or somebody very skilled at wound closure usually has to be involved in order to handle complications or reduce scar formation.

I would not offer hypothetical advice on a wound I never saw, but do try to remember one of the purposes of skin is to protect against infection.

 

[usafmedic45]

Delayed wound closure is tertiary wound closure.

secondary is no active attempt at closure and letting the wound heal by epithelialization.

My apologies. I've been reading a lot of 1940s textbooks for my medical reenacting group lately and they use the term secondary to indicate a delayed closure. Must have overwritten the modern information in my brain. LOL

 

[Veneficus]

My apologies. I've been reading a lot of 1940s textbooks for my medical reenacting group lately and they use the term secondary to indicate a delayed closure. Must have overwritten the modern information in my brain. LOL

No worries, thought you were pulling one of my moves and thinkng 2 thoughts and typing something that comes out as a little bit of both and lots of neither.

 

[mikie]

Results

Here is a link to the photo; I didn't want to post it on the boards just cause there's probably some policy about openly displaying injured wounds. Picture was taken 48 hrs after injury (before seeing the ED doc)

Had it looked at by an ED doc (since urgent care has a strict "8 hr policy") and he said he wouldn't close it cause risk of infection was too great and it would ultimately have the potential to seal in the bacteria. It'll heal from "the bottom up" (in his words) naturally and close in time, with a funky scar. This was ~50-60 hours after the wound occurred. PA cleaned it, put in an antibacterial gel, 4x4 and wrapped in Kling; Rx'd Keflex.