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Suturing versus conservative management of lacerations of the hand: randomised controlled trial
James Quinn1, Steven Cummings, Michael Callaham
1Division of Emergency Medicine, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0208, USA. quinnj@medicine.ucsf.edu
Objective:
To assess the difference in clinical outcome between lacerations of the hand closed with sutures and those treated conservatively.
Design:
Randomised controlled trial.
Setting:
Emergency department in a tertiary hospital.
Participants:
Consecutive patients presenting between 16 February and 30 November 2000 with uncomplicated lacerations of the hand (full thickness <2 cm; without tendon, joint, fracture, or nerve complications) who would normally require sutures. 154 patients were eligible, 58 refused, and 5 were missed; 91 patients with 95 lacerations were enrolled.
Intervention:
Participants were randomised to suturing or conservative treatment.
Main Outcome Measures:
Primary outcome was cosmetic appearance after three months, rated on a previously validated visual analogue scale. Duration of treatment, pain during treatment, patients' assessment of their outcome, and the time for patients to resume normal activities were also measured.
Results:
Participants treated with sutures and those treated conservatively did not differ significantly in the assessment of cosmetic appearance by independent blinded doctors after three months: 83 mm v 80 mm, (mean difference 3 (95% confidence interval -1 to 8) mm) on the visual analogue scale. The mean time to resume normal activities was the same in both groups (3.4 days). Patients treated conservatively had less pain (difference 18 (12 to 24) mm) and treatment time was 14 (10 to 18) min shorter.
Conclusion:
Similar cosmetic and functional outcomes result from either conservative treatment or suturing of small uncomplicated lacerations of the hand, but conservative treatment is faster and less painful.