Procedure: Sutures and Staples

The Procedure

Hello again from the Emergency Procedures team, Today we cover a core procedure, closing lacerations.

Simple suture, advanced skills and stapling

Detailed written instructions and explanation are available here and in our Free App (iOS and Android). This video is hot off the press and we want your help improving it. Drop us a line with any suggestions

So, without further ado…here are the videos

The rationale…

Which wounds should be closed in the Emergency Department?

Any wound presenting within 24 hours that is clean after irrigation and free of high-risk features (such as neurovascular compromise or deep structure involvement) can generally be closed in ED. Wounds that remain visibly contaminated should be left open for secondary intention healing.

What’s the best way to assess and clean a wound prior to closure?

Position the patient comfortably and prepare the area with PPE. Begin with high-volume irrigation under pressure. Tap water is safe and effective. For visibly contaminated wounds, scrub with moist gauze. Explore the full depth of the wound with a blunt probe. If contamination persists, surgical consultation is preferred over closure.

When is suturing preferred over glue?

Sutures are ideal when precise wound edge alignment is required, especially on the face, over joints, or in irregular lacerations. They are also preferred for wounds that are under tension, which should not be closed with glue. Use simple interrupted sutures for most closures. Horizontal, vertical mattress, or corner stitches may be used for wounds under tension or involving angled edges.

How do I instil anaesthetic into a wound?

Use a 25G needle and infiltrate along the wound edge subcutaneously while withdrawing. Fewer punctures means less pain.

Are staples useful?

Occasionally. Staples are fast and effective for clean, linear scalp lacerations in adults. They are less suitable in children, on cosmetically sensitive areas, or where precise wound edge alignment is needed. Removal can be painful, so discuss this with the patient during repair.

After closing a laceration, should I discharge the patient on antibiotics?

Routine antibiotics are not required for clean, uncomplicated lacerations. Consider antibiotics only for wounds at high risk of infection, such as bites, delayed presentations, heavily contaminated wounds, or in immunocompromised patients.

What type of suture should I use for a simple external laceration?

Use a monofilament (low infection), synthetic (strong), non-absorbable suture (will last until removal) such as nylon or polypropylene. Don’t worry too much about the suture type if you are overwhelmed — it has only a small impact on the result. Read our discussion section for full details

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