The majority of hand cuts don't need stitches

Treating small lacerations to the hand with antibiotic ointment and a gauze dressing --instead of with stitches -- is faster, less painful, and produces similar functional and cosmetic results, according to UCSF researchers.

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

Contact: Maureen McInaney
University of California - San Francisco

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