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


CONCLUSIONS
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.
Department of Emergency Medicine, Royal Columbian Hospital, New Westminster, BC. peter.macdonald@fraserhealth.ca
Peter
P
Macdonald
Nadia
N
Primiani
Adam
A
Lund
D000328:Adult; D001955:British Columbia; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D022125:Lacerations / Q000601:surgery*; D008297:Male; D009819:Office Visits / Q000706:statistics & numerical data; D011446:Prospective Studies; D012648:Self Care; D016037:Single-Blind Method; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D013537:Sutures; D014946:Wound Infection / Q000453:epidemiology