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Are patients willing to remove, and capable of removing, their own nonabsorbable sutures?

Published online by Cambridge University Press:  11 May 2015

Peter Macdonald ,
Nadia Primiani  and
Adam Lund
Peter Macdonald*
Affiliation:
Department of Emergency Medicine, Royal Columbian Hospital, New Westminster, BC
Nadia Primiani
Affiliation:
Department of Family Practice, University of British Columbia, Vancouver, BC
Adam Lund
Affiliation:
Department of Emergency Medicine, University of British Columbia, Vancouver, BC
*
330 East Columbia Street, New Westminster, BC V3L 3W7; peter.macdonald@fraserhealth.ca.

Abstract

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Objectives:

Providing patients with instructions and equipment regarding self-removal of nonabsorbable sutures could represent a new efficiency in emergency department (ED) practice. The primary outcome was to compare the proportion of patients successfully removing their own sutures when provided with suture removal instructions and equipment versus the standard advice and follow-up care. Secondary outcomes included complication rates, number of physician visits, and patient comfort level.

Methods:

This prospective, controlled, single-blinded, pseudorandomized trial enrolled consecutive ED patients who met the eligibility criteria (age > 19 years, simple lacerations, nonabsorbable sutures, immunocompetent). The study group was provided with wound care instructions, a suture removal kit, and instructions regarding suture self-removal. The control group received wound care instructions alone. Outcomes were assessed by telephone contact at least 14 days after suturing using a standardized questionnaire.

Results:

Overall, 183 patients were enrolled (93 in the intervention group; 90 in the control group). Significantly more patients performed suture self-removal in the intervention group (91.5%; 95% CI 85.4–97.5) compared to the control group (62.8%; 95% CI 52.1–73.6) (p < 0.001). Patients visited their physician less often in the intervention group (9.8%; 95% CI 3.3–16.2) compared to the control group (34.6%; 95% CI 24.1–45.2%) (p < 0.001). Complication rates were similar in both groups.

Conclusion:

Most patients are willing to remove, and capable of removing, their own sutures. Providing appropriate suture removal instructions and equipment to patients with simple lacerations in the ED appears to be both safe and acceptable.

Keywords

suturesuture removalwound care
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 14 , Issue 4 , July 2012 , pp. 221 - 227
Copyright
Copyright © Canadian Association of Emergency Physicians 2012

References

REFERENCES

1.Garcia-Gubern, CF, Colon-Rolon, L, Bond, MC. Essential concepts of wound management. Emerg Med Clin North Am 2010;28:951–67, doi:10.1016/j.emc.2010.06.009.Google Scholar
2.Richardson, M. Wound closure. Emerg Nurse 2003;11:25–32.Google Scholar
3.Karounis, H, Gouin, S, Eisman, H, et al. A randomized, controlled trail comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus nonabsorbable nylon sutures. Acad Emerg Med 2004;11:730–5.Google Scholar
4.Macdonald, P. EP Current Practice Survey. RCH Online. Available at: http://www.rchemerg.com/Academics/Academic-Projects-at-ERH-and-RCH/Suture-Removal-By-Patients/EPCurrent-Practice-Survey (accessed June 4, 2011).Google Scholar
5.DeBoard, RH, Rondeau, DF, Kang, CS, et al. Principles of basic wound evaluation and management in the emergency department. Emerg Med Clin North Am 2007;25:23–39, doi:10.1016/j.emc.2006.12.001.Google Scholar
6.Patel, PR, Miller, MA. Postcare recommendations for emergency department wounds. Emerg Med Clin North Am 2007;25:147–58, doi:10.1016/j.emc.2007.01.006.Google Scholar
7.Pfaff, JA, Moore, GP. Reducing risk in emergency department wound management. Emerg Med Clin North Am 2007;25:189–201, doi:10.1016/j.emc.2007.01.009.Google Scholar
8.Capellan, O, Holander, JR. Management of lacerations in the emergency department. Emerg Med Clin North Am 2003;21:205–31, doi:10.1016/S0733-8627(02)00087-1.Google Scholar
9.Wound care instructions adapted from the University of Virginia Department of Dermatology. Available at: http://www.virginia.edu/uvaprint/HSC/pdf/051060.pdf (accessed March 15, 2010).Google Scholar
10.Image on suture removal instructions. Available at: http://www.made-in-china.com/image/2f0j00gvQESBarOVqeM/Suture-Removal-Kit.jpg (accessed March 15, 2010).Google Scholar
11.Bergman, R. Stitching a cut. Image on suture removal instructions. Anatomy Atlases. Available at: http://www.anatomyatlases.org/firstaid/images/suturesD.jpg (accessed June 4, 2011).Google Scholar
12.Albert, M, Daly, A, Krueger, J, et al. Self-removal of sutures by emergency department patients [abstract]. Ann Emerg Med 2009;54(3 Suppl):133, doi:10.1016/j.annemergmed.2009.06.461.Google Scholar
13.Doto, TA, Killick, SR. The use of a self-removal prolene suture after daycase laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 2006;16:334–7, doi:10.1097/01.sle.0000213743.08149.ce.CrossRefGoogle ScholarPubMed
14.Alkan, M, Gefen, Z, Golcman, L. Wound infection after simple suture at the emergency ward. Infect Control 1984;5:565.CrossRefGoogle ScholarPubMed
15.Rutherford, WH, Spence, RAJ. Infection in wounds sutured in the accident and emergency department. Ann Emerg Med 1980;9:350–2, doi:10.1016/S0196-0644(80)80110-7.Google Scholar
16.Seaman, M, Lammers, R. Inability of patients to self diagnose wound infections. J Emerg Med 1991;9:215–9, doi:10.1016/ 0736-4679(91)90416-D.Google Scholar