A new approach to the management of pretibial lacerations.

Accident and Emergency Department, Whipps Cross Hospital, E11 1NR, London, UK.

This paper describes a technique for the management of pretibial lacerations by deep reinforced suturing through steristrips, which are applied parallel to the wound edges. This is carried out under local anaesthesia and followed by application of gentle localised compression dressing. Typical victims of pretibial lacerations are the elderly and patients on long-term systemic steroid therapy. This suturing technique, which was used on both flap and linear lacerations, obliterates the dead space in the wound and prevents tearing of the thin, fragile skin of these patients. The dressing technique used, has a great advantage over the toes to knee pressure dressing currently used for such lacerations, because it frees the foot of bandaging and allows the patients (especially the elderly with decreased mobility) to wear their normal footwear immediately post-operatively and to maintain their normal mobility. In the total sample of 147 patients treated by this method, the average healing time was 26 days for 112 patients with flap lacerations, and 16 days for the remaining 35 patients with linear lacerations. This is significantly shorter than that reported in the medical literature using both non-operative methods and simple suturing. Moreover, none of these patients required skin grafting or hospitalisation (except for social reasons).

PMID: 11382421 [PubMed - indexed for MEDLINE]