Monthly Archives: September 2014

Reader Question: Must Uncomplicated Lacerations Be Repaired Within Eight Hours?

Dr. Keller,
What do you think of the rule for lacerations that says a laceration has to be sutured within six hours or it cannot be sutured at all? At our facility, we send lots of inmates to the ER for simple cuts because the PA isn’t scheduled to be at the facility until the next day. If a cut is 10 hours old, why can’t it be fixed?  Where did this rule come from?
Kim A.

Thanks for the question, Kim. The short answer to this question is that that this belief is a myth. Uncomplicated lacerations can, indeed, wait more than 6 hours to be repaired.

“There is a common misconception that all wounds must be either sutured within a few hours or left open and relegated to slow healing and an unsightly scar.”  Roberts and Hedges’ Clinical Procedures in Emergency Medicine

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Diuretics for Swollen Legs? Not!

Originally printed September 2012

I recently had several women inmates at one of my jails complain that their legs were swollen and request a “water pill” to get rid of the swelling. This happens now and again at the jails and seems to occur in waves; I will see a bunch of requests for water pills to help leg swelling, then nothing for a while, then it recurs. Having the suspicious mind that I do, I often suspect that the real reason for the water pill request is weight loss.Once, in fact, an inmate admitted that the women in her dorm were having a weight loss contest and that was why we were seeing so many complaints of constipation and water retention.

However, some patients have simply been taught by other medical providers, either in corrections or out, that the reason that their legs swell at the end of the day is “fluid retention” and the solution is “water pills.” Both notions are wrong for the vast majority of the patients I see.  The cause of their ankle swelling is NOT fluid retention and diuretic “water pills” will not help them. Continue reading