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Spare the Sutures

ER study says bandages sometimes enough for cut hands

THURSDAY, Aug. 8, 2002 (HealthDayNews) -- A stitch in time is often not necessary, says a California physician who has studied the wisdom of sewing up hand cuts in the emergency room.

It wasn't easy to do, says Dr. James Quinn, an associate clinical professor of emergency medicine at the University of California, San Francisco. That's because he did it the scientifically correct way, with a control group of patients who didn't get sutures for their wounds.

"A lot of people said, 'You're crazy, this is bleeding,'" Quinn recalls. "It was hard to convince people that what we were doing was reasonable."

Nevertheless, Quinn persisted enough to get 91 people who came to the UCSF emergency room with 95 cuts on their hands enrolled in the study; another 58 of the wounded turned him down. All the patients were adults; "children generally get forehead lacerations," Quinn explains.

Patients in both groups started with the standard treatment, having the cut washed with tap water and then applying pressure to stop any bleeding. If bleeding did not stop after 15 minutes or if the patient was in the group slated for stitches, the wounds were sutured, an antibiotic ointment was applied and the site was bandaged. Patients in the no-suture group got ointment and bandage without stitches.

After three months, Quinn had other doctors compare 41 cuts that had been sutured with 40 that had been bandaged without stitches.

The patients also were asked about the appearance of the cut after it healed. They and the doctors agreed there was no cosmetic difference.

On every other count, the no-stitch wounds scored equal or better. The time to return to normal activity was identical, an average of 3.4 days. Only 13 of the no-stitch patients reported pain during the treatment, compared to 34 of those who got sutures. Treatment was quicker -- five minutes for bandages, 19 minutes for sutures. None of the bandaged wounds became infected; one of those given stitches did.

Better yet, the people who didn't get stitches were just as satisfied with their treatment as those who did.

These were not major wounds; they were less than an inch in length. However, in the emergency room, Quinn says, "anything that can save us time is a great thing, and not suturing saves us time."

A report on the study in this week's British Medical Journal is careful to say that "large gaping wounds should be closed, after meticulous wound care, and our results cannot be generalized to cosmetically sensitive areas such as the face."

The study excluded people with potential bleeding problems, such as those who had diabetes or who were taking an anti-clotting drug.

Quinn says he got the idea for the study in the course of developing glue to bind wounds; one of his products is now on the market and others will be in the near future, he says.

"When I worked on the clinical studies, I was always surprised that the wound was OK when the glue fell off," he says.

The study has changed the way he treats cuts now, Quinn adds: "Now I think twice about using sutures."

What To Do

You can get advice about first aid for cuts and other problems from the Mayo Clinic or Harvard Medical School.

SOURCES: James Quinn, associate clinical professor, emergency medicine, University of California, San Francisco; Aug. 10, 2002, British Medical Journal
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