18 Reasons Not To Suture A Wound
Sutures, most commonly known as stitches, are the single most familiar method used to close a wound of any significance. It doesn’t seem to matter if it was a playground accident or a bar fight, there are many injuries that rely on being sewn (sutured) shut to promote healing and provide a pleasant looking end result. Not only because of their effectiveness but the level of appeal that sutures have, it seems that any wound that is serious in appearance warrants sutures in the eye of the person who does not know any better.
While there are probably hundreds, if not thousands of different types of lacerations and wounds that get sutured, there are many reasons NOT to suture a wound. This part can be tricky because when a wound is really long, deep, or both; it can seem like the only right thing to do is to close it up with sutures. This is not always the appropriate choice and the distinction is important to be able to make. This is especially true in a survival situation where further care may not be available within a reasonable distance, if at all.
Here are some of the most common reasons that a wound should not be sutured (contraindications):
- Any wound that is more than six hours old.
- A wound that is dirty with severe contamination that requires extensive cleaning or debridement.
- Some concave skin surfaces like the temple is best healed through secondary intention (natural healing).
- Complex structures like the eyelid require complicated repair and should not be closed.
- Damaged tissue, especially in severe wounds, crush injuries, and gunshot wounds.
- Any bite wounds whether from an animal or a human.
- All open fractures.
- Absorbable sutures should not be used where prolonged approximation (joining) of tissue under stress is required due to risk of potential tearing of the tissues.
- If the patient is set to go on a long journey/prolonged travel.
- All wounds that are a result of combat.
- Any wound that involves a tendon, nerve, or major blood vessel injury.
- Any wound that is so severe that anesthesia cannot be obtained without a toxic dose of local anesthesia or sedation.
- Silk sutures should not be used in any patient with an allergy to silk or silk products as well as in any location where permanent retention of tensile strength is required.
- Most open joint wounds.
- A wound should not be closed if antibiotics are not available to treat an infection if one becomes present.
- If the patient has a known allergy to collagen or chromium, neither plain or chromic gut sutures should be used to avoid potential allergic reaction.
- The wounds of a patient that is in severe shock should not be closed because of the risk that poor peripheral circulation could hinder proper wound repair and healing.
- Avoid suturing a wound that may have to be treated with skin grafting (degloving injuries, etc.)
With all of that being said, while the reasons listed above are all reasons to not suture a wound, many of these reasons are just indicators to delay closure of the same wound. You can take several of the reasons listed above to not suture a wound and change the circumstances by introducing the ability to clean the same wound or the availability of antibiotics and the reason to not suture the wound is gone. This may delay the closure but does not ultimately rule out sutures in the long run.
The importance of knowing when to suture a wound and perhaps more importantly, when not to is applicable to everyone. You may not be the one that is doing the suturing but you still need to know this information. What if you see a person that was going to suture a dirty wound shut? You now know that a dirty wound should not be closed. This knowledge could potentially save the life of that person. Closing that dirty wound could lead to an infection that if not properly treated could eventually result in death. It is probably just best to know better to begin with.
For more information about sutures, please download the Wound Closure Manual on the downloads page.