Suturing v conservative management of hand lacerations
Authors: B. A De Souza
Journal: BMJ (2002)

# All lacerations need to be examined thoroughly {#article-title-2} EDITOR—Quinn et al show that conservative treatment is faster and less painful for small uncomplicated lacerations of the hand.1 However, we think that lacerations to the hand, no matter how small, must be examined thoroughly to exclude injuries to tendons, nerves, or joints. The authors make no comment on the mechanism of injury, which is extremely important. A knife stab laceration or glass injury to the hand would make exploration of the wound mandatory. An unimpressive skin wound may hide a remarkable amount of damage to deep structures.2 Similarly, injuries caused by thin slivers of glass produce unimpressive skin wounds but commonly divide flexor tendons and nerves in the forearm.3 In emergency settings we think that it is crucial to take a good history from the patient about the mechanism of injury and to examine the patient thoroughly before deciding on further management of hand lacerations, albeit suturing or conservative management. In our plastic surgery unit the nurse practitioners who refer cases of hand trauma to us have all been on a hand trauma study day organised by our department. If the mechanism of injury raises any suspicion of a tendon or nerve injury, patients are referred to us and their wounds formally explored in an operating theatre. 1. ↵1. Quinn J, 2. Cummings S, 3. Callaham M, 4. Sellers K . Suturing versus conservative management of lacerations of the hand: randomised controlled trial. BMJ 2002; 325: 299–300. (10 August.) [OpenUrl][1][Abstract/FREE Full Text][2] 2. ↵1. Schwager RG, 2. Smith JW, 3. Goulian D . Small deep forearm lacerations. Plast Reconstr Surg 1975; 55: 190–194. [OpenUrl][3][PubMed][4] 3. ↵1. Joseph KN, 2. Kalus AM, 3. Sutherland AB . Glass injuries of the hand in children. Hand 1981; 13: 113–119. [OpenUrl][5][CrossRef][6][PubMed][7][Web of Science][8] # Hand lacerations should be explored before conservative treatment {#article-title-6} EDITOR—We are surprised by the publication of the article by Quinn et al on conservative treatment of small … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DQuinn%26rft.auinit1%253DJ.%26rft.volume%253D325%26rft.issue%253D7359%26rft.spage%253D299%26rft.epage%253D299%26rft.atitle%253DSuturing%2Bversus%2Bconservative%2Bmanagement%2Bof%2Blacerations%2Bof%2Bthe%2Bhand%253A%2Brandomised%2Bcontrolled%2Btrial%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.325.7359.299%26rft_id%253Dinfo%253Apmid%252F12169503%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=325/7359/299&atom=%2Fbmj%2F325%2F7372%2F1113.atom [3]: {openurl}?query=rft.jtitle%253DPlastic%2Band%2Breconstructive%2Bsurgery%26rft.stitle%253DPlast%2BReconstr%2BSurg%26rft.aulast%253DSchwager%26rft.auinit1%253DR.%2BG.%26rft.volume%253D55%26rft.issue%253D2%26rft.spage%253D190%26rft.epage%253D194%26rft.atitle%253DSmall%252C%2Bdeep%2Bforearm%2Blacerations.%2BDifferential%2Bdiagnosis%2Bof%2Bmuscle%2Band%2Bnerve%2Binjuries.%26rft_id%253Dinfo%253Apmid%252F1118476%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/external-ref?access_num=1118476&link_type=MED&atom=%2Fbmj%2F325%2F7372%2F1113.atom [5]: {openurl}?query=rft.jtitle%253DThe%2BHand%26rft.stitle%253DHand%26rft.aulast%253DJoseph%26rft.auinit1%253DK.%2BN.%26rft.volume%253D13%26rft.issue%253D2%26rft.spage%253D113%26rft.epage%253D119%26rft.atitle%253DGlass%2Binjuries%2Bof%2Bthe%2Bhand%2Bin%2Bchildren.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0072-968X%252881%252980050-2%26rft_id%253Dinfo%253Apmid%252F7286795%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/external-ref?access_num=10.1016/S0072-968X(81)80050-2&link_type=DOI [7]: /lookup/external-ref?access_num=7286795&link_type=MED&atom=%2Fbmj%2F325%2F7372%2F1113.atom [8]: /lookup/external-ref?access_num=A1981LZ45900001&link_type=ISI