When Can You Close That Stab Wound?
I find that many trauma professionals are nervous about closing stab wounds. They seem to worry a lot about infections and lean toward leaving the wound open to heal by secondary intention. But is this warranted?
The answer is: probably not. Most knives used for assaults are clean, but not quite sterile. Yes, there are a few bacteria on the blade, but not very many. So if the usual wound management guidelines are followed, the patients generally do quite well.
The guidelines are:
- No gross contamination. If the knife was used to cut raw chicken or to stir up manure, that’s a problem. Leave it open.
- No devitalized tissue. Complex lacerations with dusky skin bridges may get infected. Debride or leave open.
- Don’t let the wound get fully colonized with skin bacteria. There is no good literature on this, but more than 12 hours for most of the body and 24 hours for the face is a reasonable guideline.
If any of these guidelines have been violated, it’s probably best to leave the wound open. Otherwise the default should be to try to close it as soon and as cleanly as possible. This means irrigating with saline to decrease any bacterial counts. Either sutures or staples are acceptable.
The most important part of this process is patient education. They must be informed about what signs of a wound infection to look for so they can return earlier rather than later to have you deal with it.