When I started working on this lecture series, I noticed how the overwhelming majority of information was NOT related to the act of suturing. That’s how I came up with this 90/10 statistic. It’s from my own experience, not a randomly controlled clinical trial, so don’t run to the Cochrane Database to prove or disprove it!
If you think about it, ED techs and military corpsman/women are able to suture, with a fraction of the education that we have. The actual suturing can be taught to most anyone, and at the end of the day, its not hard, it just takes a lot of practice to be really good. The hard parts come when you are faced with a complex medical patient with a laceration. Diabetic with COPD on warfarin for atrial fibrillation who comes in 24 hours after a lower leg laceration that continues to bleed. Do you suture this or not? Well, that’s where the 90% comes in.
You know that DM and steroid use impair healing. With these comorbidities, they likely have PAD, so healing will be compromised. After 8 hours, the risk of infection with primary closure skyrockets. You decide to do delayed primary closure or even healing by secondary intention and close follow-up back in the ED, with wound care clinic, or with their PCP. Sometime the answer is “Don’t just do something, stand there!”
You have to know the basics to truly be able to best care for patients with lacerations. Join me in The Laceration Course: https://www.ebmedicine.net/tlc
Sincerely,
Dr. Patrick O’Malley
The Laceration Course, Course Director
Even more content:
Watch my reel (less than one minute) on the figure of 8 stitch!
Patrick O’Malley is an emergency physician and course director of The Laceration Course and The Abscess Course. Follow him bellow for more…
