Do I Need Stitches?
Evaluating an Open Wound for Sutures
The first concern with open wounds is to control bleeding. If the wound is on a victim other than yourself, be sure to stay safe and follow universal precautions, using personal protective equipment if available.
When evaluating a wound to decide if it needs stitches, there are several questions that need to be answered. The first is why you are considering stitches at all. Stitches are used for two reasons.
- Close a wound to promote healing and discourage infection
- Reduce scarring
The first reason is more complicated and requires a bit more understanding.
Types of Wounds
Wounds that cause a break in the skin are called open wounds. These are the types of wounds that may require stitches. Closed wounds do not have a break in the skin and are identified by swelling and bruises.There are several types of open wounds:
- Lacerations. This is what we are thinking of when we say "cuts." Lacerations are simple breaks in the skin.
- Incisions. Surgical wounds, which are usually made by a scalpel. These are similar to lacerations, but have very smooth edges.
- Punctures. It's hard to tell a puncture from a laceration (see illustration) if the item that made the wound is big enough. Lacerations tear through the skin, while punctures go in and come back out. If the item that made the puncture is still imbedded, it's called an impaled object.
- Avulsions. These are torn sections of skin, either a flap open on three sides or torn away completely.
- Abrasions. These are scratches. The difference between an abrasion and an avulsion is the depth. Abrasions leave the skin mostly intact, while avulsions remove the skin entirely.
So, Do I Need Stitches?
Lacerations, punctures, and incisions are all suturable wounds (can be stitched). Avulsions that still have a flap of skin attached may also be suturable. Complete avulsions and abrasions are not suturable, but still my need a doctor if they are serious enough.To determine if stitches are needed, look at three things:
- Depth. Is the wound deep enough to see the subcutaneous tissue (yellowish fatty tissue)? If so, the wound is deep enough to get stitches, but still may not need them.
- Width. Can the wound be pulled closed easily? If the wound is gaping and cannot be easily pinched closed, then it will need stitches to hold it closed long enough to heal correctly.
- Location. Wounds on areas of the body that stretch and move a lot will need stitches more often than those on areas that do not move as much. For example, a wound on the forearm will not move as much as a wound on the calf, so it would not necessarily require stitches.
Open Wounds that Should Always Go to a Doctor
These are the wounds - and the victims - that should always go to the doctor:- Diabetic victims
- Animal or human bites (remember, we're talking about open wounds)
- Dirt that won't come out of the wound
- Can't close the edges of the wound
- Uncontrolled bleeding - Call 911
Soft Tissue Injuries
Emergency Wound Care
Cleaning and Dressing of Open Wounds
Plain tap water is the best for cleaning cuts.
For a demonstration of cleaning and dressing minor wounds, watch the Wound Dressing Video.
Cleaning an Open Wound
Once bleeding has been controlled, the open wound should be cleaned with mild soap and water (see illustration). Liquid soaps do a great job, and there is no need for fancy antibacterial soaps. Be sure to rinse the entire depth of the cut, and rinse the soap from the surface thoroughly.Water sometimes has a tendency to sting. Saline solution (0.9% salt solution) can be a little easier on tender skin. Bottled water can do double duty in a first aid kit that's tight on space or weight (you can wash with it or drink it), but saline solution is better for cleaning wounds and eyes.
Keeping a wound clean is as important as cleaning it the first time. If it seems a wound has become contaminated or dirty after it was been cleaned and dressed, remove the dressing and clean it again. Keeping a wound clean is the best way to avoid infection.
Cleaning an open wound can sometimes cause bleeding to return. The bleeding will be minor and should be easily stopped with direct pressure using a sterile - or at least clean - dressing. Once the bleeding has been stopped, it's time to dress the wound.
Dressing an Open Wound
Don't dress a wound without first cleaning it as well as possible. Do not dress a wound with visible contamination. If you can't get it clean, leave it open and seek medical attention.Once the wound is clean and not bleeding, dab a bit of antiseptic ointment on it to keep out the germs. Cover the wound lightly with an adhesive dressing. If body hair gets in the way of an adhesive dressing, you may wrap the extremity loosely with a wide roller gauze. Always change dressings every 12 hours.
For lacerations and incisions, pull the edges of the wound together and use butterfly enclosures to hold them. Avulsions with a flap of skin can be closed and butterfly enclosures applied as well. Apply antiseptic ointment over butterfly enclosures and cover with a bandage as above. Superficial wounds, those that are not deep enough to see subcutaneous (fatty) tissue, do not need butterfly enclosures.
If a wound resumes bleeding at any point, follow the steps to control bleeding. If bleeding doesn't stop, you may need to seek medical attention. If at any point the victim gets pale, dizzy, or weak, call 911 and treat for shock.
How Long Do I Have to Get Stitches?
If stitches are necessary, you will need to keep the wound closed with butterfly enclosures until you can get to an emergency room or urgent care clinic. Remember always, keep it closed and keep it clean.How much time you have depends on a number of factors. If the wound has a high likelihood of contamination, then you have about six (6) hours to get stitches before the wound will become too contaminated to stitch. Some wounds are not generally stitched because of severe contamination, human or animal bites are good examples.
Wounds with less chance of contamination may be stitched as long as eight (8) hours after the injury. Depending on the wound, scarring can be minimized as long as 24 hours after the injury, but the longer you wait, the less likely that stitches will be possible.
For wounds that have other complications like numbness or decreased movement, seek medical attention immediately.
Complications of Open Wounds
Infection is the most common complication of an open wound. If you experience any of the following symptoms after sustaining an open wound, consult a doctor:- Tenderness or inflammation around the wound
- Fever
- Swelling around the wound
- Numbness around the wound
- Red streaks around the wound
What is Tetanus?
Tetanus is a serious infection that can lead to spasms in the jaw - commonly called Lockjaw - and possibly death. It is easily blocked with a simple vaccination. If you haven't had at least three tetanus vaccinations with the last being within ten (10) years, it's time to get a tetanus shot.
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