When to suture guidelines

[LoveandHate]

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How do you know when a lac merits a suturing... What are the precise guidelines? Where do you draw the line for small lacs, particularly small lacs to the face.

 

[deleted109597]

If it gaps, it gets closure. This can be adhesive strips, tissue adhesive, or sutures. Your choice.
I don't have a length requirement.

 

[EM_Rebuilder]

Tissue adhesives are golden for small lacs.... I tend to use it even if the lac 'probably would be ok without doing anything'. It helps keep the wound sealed off and decreases pain...... and increases patient satisfaction.

Patients tend to be unhappy when they wait 3 hours, get seen and you say 'just keep it clean, it will do alright'.... versus, "I think we can get by with just skin super glue on this cut'...

Patient satisfaction becomes rather important 'in the real world'...

I guess what I am sayin.. if it obviously needs stitches, use stitches. If its probably fine without anything, use some glue. If its a 'tweener', ask the patient their preference. Many people say 'I'd rather have a scar and some glue than no scar and sutures'... and then document that...

 

[LoveandHate]

Thanks!!!

 

[ALFI]

Ahh this reminds me of the home job i did. knee lac about 3-4cm long and you could see the bone..no transport to a hospital or medical care facility, it was easter and i was house sitting....Google was my best friend along with hot water and a BBQ lighter and ice 🙂 i did a nice job to...no needle driver/needle holder to help.

 

[link2swim06]

Ahh this reminds me of the home job i did. knee lac about 3-4cm long and you could see the bone..no transport to a hospital or medical care facility, it was easter and i was house sitting....Google was my best friend along with hot water and a BBQ lighter and ice 🙂 i did a nice job to...no needle driver/needle holder to help.

Interesting method...but i have to ask...what was the lighter for, was it suppose to "sterilize" it? If so i will refer you to microbiology textbook.

 

[deleted65604]

If they present to the ER, I generally suture it. Kids I will actually use glue if indicated just because they are a pain in the butt to hold down. If an adult is stupid enough to come to the ER for a paper-cut, they deserve 3 CC's of lidocaine injected super-fast, followed by a repair that we bill them hundred's of dollars for. In other words, punitive stitches. My previous boss taught me that gluing is not a well-reimbursing procedure. Stitches are. So if you have any doubt, and the patient is expecting it, I suture.

 

[Birdstrike]

.

 

[ALFI]

Interesting method...but i have to ask...what was the lighter for, was it suppose to "sterilize" it? If so i will refer you to microbiology textbook.

yes i know but with no transport and it being easter...didn't really have much of a choice so i put everything in boiling water from the kettle first and then after that used the lighter to somewhat autoclave the needle. we learn from an early age how to survive.

 

[danzman]

yes i know but with no transport and it being easter...didn't really have much of a choice so i put everything in boiling water from the kettle first and then after that used the lighter to somewhat autoclave the needle. we learn from an early age how to survive.

I maintain that soapy water followed by etoh and fire will kill anything.