• Mark T M van den Baar, Marianne I Vroon, Paul Bertelink, and Ron Hendrix.
• Department of Surgery and Microbiology, Medisch Spectrum Twente, Enschede, The Netherlands. vandenbaar@hotmail.com
• Emerg Med J. 2010 Jul 1;27(7):540-3.

BackgroundThe dogma that traumatic wounds should not be sutured after 6 h is based on an animal experiment by P L Friedrich in 1898. There is no adequately powered prospective study on this cut-off of 6 h to confirm or disprove the dogma. The aim of this study was to provide evidence against the dogma that wounds should be sutured within 6 h after trauma.Method425 patients were included in a prospective cohort study. Patients' wounds were closed, independent of time after trauma. All patients were seen after 7-10 days for removal of stitches and wound control on infection.ResultsOf the 425 patients, 17 were lost to follow-up. Of the remaining 408 patients, 45 had wounds older than 6 h after trauma. At follow-up 372 patients (91%) had no infection and 36 patients had redness of the suture sites or worse. 11 patients (2.7%) had general redness or pus. Of those with a wound older than 6 h, three of 45 (6.7%) wounds were infected, versus 30 of 363 (9.1%) in wounds younger than 6 h (p=0.59).ConclusionIn everyday practice wounds are sutured regardless of elapsed time. Here an attempt was made to present the evidence for this daily routine, contrary to Friedrich's Dogma.

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