Nonoperative Management of Pretibial Lacerations in a Nurse-Led Clinic: An Observational Study

In our tertiary plastic surgery center, patients with wounds that will not be treated surgically, including complex pretibial wounds, that would traditionally have been managed operatively are managed on an outpatient basis in a nurse-led pretibial laceration clinic. We conducted a study to investigate dressing usage and assess correlators with healing time or number of appointments. We collected data regarding dressings used, time to discharge, and number of appointments retrospectively over 14 months between 2019 and 2021. We analyzed the data using linear regression and set the significance at p < .05. We accepted 138 patients for review and dressing management including 76 patients who had been discharged from the clinic at the time of data collection. The median age was 80 years (interquartile range [IQR] 14, 73-87). Time to discharge ranged from 0 to 201 days (median 24.5, IQR 68.5). The number of appointments ranged from 1 to 19 (median 3, IQR 7.25). Linear regression indicated that the number of different types of dressings used was statistically correlated with time to discharge (R2 = 0.230, F(1,74) = 22.1, p < .005). Similarly, the correlation between the number of dressings used and the number of total appointments was also statistically significant (R2 = 0.246, F(1,74) = 24.1, p < .005). In patients with conservatively managed pretibial lacerations, the total number of different dressings used (as a surrogate marker for wound complexity ) is predictive of the time the patient spends in follow-up and the total number of hospital contacts. These data may be used to help understand when conservatively managed pretibial lacerations may require more intensive intervention.