On the Third Day of Christmas, Daddy gave to me- no sutures!

Welcome to the Twelve Trials of Christmas series on EMinFocus!  This is the third of twelve posts in a series where I ramble on various topics for which I would love to see an EM study done.  I’ve taken morsels of prior studies (case series, small trials, etc) and highlight reasons on why I believe this study would benefit EM.  Some may pan out, some may not.  All of them I would be highly interested in assisting with in any way possible to continue to advance our fine specialty

Lets cut straight to the evidence on this one:  95 uncomplicated lacerations of the hand (full thickness <2 cm; without tendon, joint, fracture, or nerve complications) who would normally require sutures were enrolled to suturing or conservative treatment.  Essentially, there was no difference in the assessment of cosmetic appearance 3 months after treatment by independent blinded doctors on the visual analogue scale.  The mean time to resume normal activities was the same in both groups.  Patients treated conservatively had less pain and treatment time was significantly shorter by 14 minutes on average.

Now, have you ever see a laceration come back for suture removal and wonder, “Why did they put so many sutures in this thing?” Brian Lin has a great post on his website about this here, and has started, what I’ve begun to call, a Lac Lookbook. Unfortunately, the referenced study is only on hand lacerations and I can not find any literature to support the 2cm cutoff on other parts of the body. I would love to see a published article on provider and parent assessment of repair 2-3 months after the initial visit for lacerations all over the body and initiate a pediatric Lac Lookbook.  This would be the Holy Grail to show parents- “look, exactly what your child has and what to expect.” This is a great way to save time, actually show parents an estimate of what to expect, save supplies, a repeat visit, and in some cases, a papoose and/or ketamine.


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