Pearls of Wisdom: Is Keeping Sutures Dry Necessary?
Earlier today, Frank, a 49-year-old construction worker, received a deep wound to his forearm while on the job. As you place the final suture to complete a laceration repair, he asks you, “Do I need to keep these dry?”
After nylon simple interrupted suture repair of a clean laceration, how should you respond to the patient’s inquiry?
A. Yes, for at least 48 hours
B. Yes, for at least 72 hours
C. No, but contact with water may slow healing
D. No, water has no known deleterious effects
What is the correct answer?
(Answer and discussion on next page)
Louis Kuritzky, MD, has been involved in medical education since the 1970s. Drawing upon years of clinical experience, he has crafted each year for almost 3 decades a collection of items that are often underappreciated by clinicians, yet important for patients. These “Pearls of Wisdom” often highlight studies that may not have gotten traction within the clinical community and/or may have been overlooked since their time of publishing, but warrant a second look.
Now, for the first time, Dr Kuritzky is sharing with the Consultant360 audience. Sign up today to receive new advice each week.
Answer: No, water has no known deleterious effects
My mother, whose only involvement with medical school was to visit me there, was nonetheless usually correct on medical issues. The common philosophy of wound healing in the 1920 to 1950 time period was that “the wound needs to be open to the air in order to ‘breathe.’”
Well, on this one, Mom may have gotten it wrong, at least according to a prospective randomized controlled trial.1
Sharp Way to Remove Tight Sutures
Suturing and Wound Closure: How to Achieve Optimal Healing
Overall, 857 patients who had undergone excision of skin lesions with suture repair were randomly assigned to a wet or dry group. Patients in the dry group were instructed to leave the dressing on and keep it dry for the first 48 hours, then bathe and undress as normal until the sutures are taken out. Patients in the wet group were instructed to remove the dressing within 12 hours, then bathe as normal until sutures are removed. Both groups were also instructed to avoid antiseptic washes and soaps.
Can Sutures Get Wet?
The primary outcome of the trial was the number of wound infections, which trended toward being less-frequent in the wet group (8.4% vs 8.9%). The authors stated that the “results indicate that patients can uncover and occasionally wet stitches in the first 48 hours after minor skin excisions without increasing the incidence of wound infection.”
What’s the “Take Home”?
Patient preference/convenience should direct suture care. Getting sutures wet in the early postoperative period does not appear to increase the risk of infection.
1. Heal C, Buettner P, Raasch B, et al. Can sutures get wet? Prospective randomised controlled trial of wound management in general practice. BMJ. 2006;332(7549):1053-1056. doi:10.1136/bmj.38800.628704.AE