Question: In patients with short lacerations of the hand, is conservative treatment as effective as suturing to close wounds?
Design: Randomized (allocation concealed), blinded (primary outcome only), controlled trial with a 3-month follow-up.
Setting: The emergency department of a university hospital in San Francisco, California, United States.
Patients: 95 patients (mean age, 39 years; 54% men) who had hand lacerations distal to the volar wrist crease. Exclusion criteria were lacerations that were >2 cm long; presentation >8 hours after the injury; inability to attain hemostasis after 15 minutes; any suspected neurovascular, tendon, joint, or bone injury; nail bed lacerations, puncture wounds, or bites from any source; patients with complications from diabetes; use of anticoagulants; or prolonged use of steroids. 85% of the patients had complete follow-up.
Intervention: Patients were allocated to conservative treatment (
n = 48) or suturing (
n = 47). Conservative treatment consisted of tap-water irrigation and the application of polymyxin B antibiotic ointment containing bacitracin, and a gauze dressing to last 48 hours. Patients in the suture group had the area of laceration anesthetized and cleansed. The skin was closed with 4-0 or 5-0 monofilament suture (United States Pharmacopeia). The same ointment and dressing were applied to last 24 to 48 hours.
Main outcome measures: The primary outcome measure was cosmetic appearance (rated by two doctors, who were blinded to the treatment groups, with use of a 0 to 100-mm [best scar] visual analog scale [VAS]). Other outcome measures were pain of treatment (0 to 100 mm [worst pain possible] VAS) and time to return to normal daily activities. An optimal wound score scale was also used, but <80% of patients were evaluated for this outcome.
Main results: The treatment groups did not differ with respect to cosmetic appearance (rated by doctors or patients) or time to return to normal daily activities (
table ). Patients in the conservative treatment group reported less pain than those in the suture group (table).
Conclusion: In patients with lacerations of the hand that were =2 cm long, conservative treatment was as effective as suturing and was associated with less pain.