6 PEM papers that could change your practice – #2 – Suturing facial lacerations

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Simon Binks, an Emergency Medicine doc in Wollongong Hospital recently gave an awesome talk on six papers that changed his paediatric emergency medicine practice in the last year. This week we are posting one each day.

You can hear the talk on Joe Lex’s Free Emergency Medicine Talks site.

See all the papers and discussion:

  1. The downsides of codeine in kids
  2. The outcomes of absorbable sutures in facial lacerations
  3. Abdo x-rays to rule out intussusception
  4. Bloods markers as predictors of serious bacterial infection
  5. High flow nasal cannulae for acute respiratory insufficiency
  6. Getting urine from neonates

Here I summarise the second paper he identified and his key points.

2. Facial lacerations – absorbable sutures might be a good idea

The Pediatric Emergency Care Journal published an article looking at a comparison of cosmetic outcomes when using absorbable versus non-absorbable sutures in paediatric facial lacerations.

Who did they look at?

This was a blinded, randomised trial in pediatric EDs in the US.

They looked at facial lacerations that were linear and 1-5cm in length.

The authors excluded bite wounds; wounds over eight hours old; and wounds that clinicians closed by tissue adhesive or steri-strips.

All wounds were closed by standard repair – deep sutures if required and then interrupted sutures in skin.

What were the groups?

Patients were randomised to nylon or absorbable surgical gut sutures – all size 5.0.

There were 98 patients initially but only 61 were still involved by the end of the study.

  • 29 patients in the absorbable sutures group and 32 in the nylon sutures group
  • All were 1-15 years
  • Groups were similar in: age; number of two-layer repairs; and the number of sutures required

What did they assess?

They reviewed wounds at 4-7 days looking for infection and at that time removed the sutures in the nylon group.

Scars were photographed at three months and the photos were rated for cosmetic appearance using visual analogue scales by three blinded PEM physicians and the children’s parents.

The parents were also given a sutures diary to document when the sutures were still visible and when they disappeared. Parents also rated  their satisfaction with the sutures.

What were the results?

In the absorbable suture group – 50% had disappeared by day 9 and all had disappeared by 2 weeks

Doctors’ visual analogue score were 10% worse for absorbable sutures

Parents’ visual analogue scores were better than the doctors’ overall.

Parents had a significant preference and higher satisfaction with absorbable sutures.

We could start to use more absorbable sutures in young patients requiring sedation to avoid sedation again to remove sutures. We could also use a finer absorbable suture than used in this study (e.g. 6.0 rather than 5.0).

References

Luck R, Tredway T, Gerard J, Eyal D, Krug L, Flood R. Comparison of cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations. Pediatr Emerg Care. 2013 Jun;29(6):691-5.

 

 

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Tessa Davis is a paediatric emergency registrar from Glasgow and Sydney, but currently living in London. Tessa tries to spend time with her 3 kids in between shifts. @tessardavis | + Tessa Davis | Tessa’s DFTB posts

Author: Tessa Davis

Tessa Davis is a paediatric emergency registrar from Glasgow and Sydney, but currently living in London. Tessa tries to spend time with her 3 kids in between shifts. @tessardavis | + Tessa Davis | Tessa’s DFTB posts