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Monday, October 24, 2022

Laceration repair

First10EM - By Justin Morgenstern - October 24, 2022
Summary
It is not even clear if the infection rate increases when patients present late after their injury. The highest quality data we have seems to suggest they don’t. If infection rates don’t change, there is no reason to treat these lacerations any differently than our usual lacerations. 
However, the evidence is imperfect, and it is possible that there is a small increase in infection in patients presenting many hours after their original injury. If the infection rate was higher, we would have to ask: what is the best treatment option when faced with a wound at high risk of infection? There is not a single emergency department trial to help us answer this question, so there is no perfect answer. However, the surgical literature suggests better outcomes, without increased rates of infection, if you just suture right away. Physiologically speaking, that makes sense to me. Knowing basic biology, there is no reason that sutures should affect infection rates in this group of patients. What is your alternative? Open wounds definitely have a high rate of infection, and worse outcomes for other important factors, like cosmesis. 
There are other reasonable questions to ask. Do patients presenting late warrant antibiotics? Does it impact your wound preparation or aftercare instructions? There doesn’t seem to be any science to answer those questions either. Personally, I just inform the patient that they might have a slightly higher risk of infection because of the delay, but repair the laceration exactly like I always do, and ask the patient to monitor closely for signs of infection.