A "Laceration" to the Old Dogma

As people say, "these times are a changing!" One issue is the below cited study- now the second of 2 large studies in the last decade, to challenge the "1970-ish" dogma of either not closing or "loosely" closing wounds that present late. Please recall that a "late" presentation can often vary by body site and proximity to and amount of circulation, so a forehead laceration at 12 hours could still be considered by many to be "fresh" but the same laceration on the anterior leg in a diabetic smoker would very correctly be viewed as "late" at 12 hours. 

http://www.jwatch.org/na33434/2014/02/07/management-lacerations-dogma-changing

If you elect to close a "late" presenting wound, please remember the overall summary of the study:

• The study advocates that a late presentation is not a factor in infection rates. Rather, location (i.e. less blood supply) and co-morbidities play a larger role.
• Focus on the crucial mention that a key issue in infection prevention is through flushing. Recall the medical school surgical rotation maxim: "The solution to pollution is dilution!" I heartily recommend for medico-legal purposes in every suture case to document the amount of flush and diluent and method. For example say, "The wound was flushed with 250 cc of normal saline via Zero Wet apparatus."
• One unofficial laceration rule is that for every centimeter of laceration aim for a "minimum" of 100cc of flush. So a 3cm laceration needs a minimum of 300cc of flush.