The study, which appears in the August 10, 2002 issue of the British Medical Journal (BMJ), 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, these lacerations, less than 2 cm in length, constituted 80 percent of cases that presented to the emergency department for treatment.
"We were impressed with how inconspicuous most scars were three months after suture-free treatment. In addition, patients had a high level of satisfaction with the appearance of these conservatively treated wounds," said James Quinn, MD, associate professor in the UCSF division of emergency medicine and lead author of the study.
Researchers identified 91 patients who came to the UCSF emergency department with uncomplicated lacerations of the hand (less than 2 cm in length) that would normally be treated with sutures. Those randomized to suture treatment had their laceration anesthetized and cleansed and the skin closed with 4-0 or 5-0 monofilament suture and standard sterile techniques. Those randomized to receive conservative treatment only received tap water irrigation and had the same antibiotic ointment and gauze dressing applied for 48 hours. Patients were asked to return in 8-10 days for their sutures to be removed or their wound 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 and 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 cm; they came to the emergency department more than 8 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 the nail bed; the injury was actually 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: Steven Cummings, MD, professor in the UCSF department of medicine and epidemiology; Michael Callaham, MD, professor in the UCSF department of emergency medicine; and Karen Sellers, RN, also in the UCSF department of emergency medicine.
This study was funded by the National Institutes of Health through the National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS).
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