What are the factors that determines if a wound is severe enough to need stitches?
What can happen if a wound that needs stitches is not stitched, but merely bandaged? Simply a longer time to heal, or what?
if you do not have it stiched up then it will have a greater chance for infection, longer healing time and the crusher, more likly to scar.
CandyMan
PS
Lots of places now use Crazy Glue to seal up wounds instead of stiches/staples. Who would have thunk it?
I consider the quantity of fluid and the rate at which it is leaving my body.
I guess that’s I came out of the emergency room with a midget construction worker hanging by his hard hat from my injury!
I don’t know specific criteria for stitching. However, based on my experience, wounds that “ought to be stitched” but aren’t: take longer to heal, tend to get infected, and leave bigger, wider scars.
things that determine IF you need stiches:
depth of wound,
diameter of wound
amount of seepage.
something that really deep should get stiches, since there’s a possibility of infection deep down and damage to other layers. (say stab wound… I knew that you could)
something wide should probably get stiches, possibility of infection and probabilty it’ll take too long to stop bleeding on it’s own. (for example, the quarter sized chunck of flesh my son managed to gouge out of his leg in the “arrow incident”)
amount of seepage - if it’s bleeding alot, you need stiches’ 'cause otherwise you’ll loose too much blood before it closes on it’s own.
as has been mentioned, NOT getting the stiches means that you increase chances for infection and scarring.
OTOH, my son’s had stiches twice - first was a scalp wound when he was 10, second was the above mentioned arrow incident when he was 13. both have left manyly looking minor scars. AND, he will attest to the fact that the getting of the stitches didn’t really hurt since they put a topical anesthetic on. now, scoot along and get those stiches. 
When do you need stiches? As unscientific as this sounds, if you encounter a wound that needs stiches, YOU’LL KNOW. Seriously. You’ll take one look at it, and having no previous medical background, you’ll think to yourself, “This sucker needs stiches.”
And usually, they don’t bleed a lot. Its just really deep. My girlfriend once got her boob cut in high school. Said she could see the fatty tissue. Didn’t bleed much at all, but really needed stiches.
I think what ties these things (healing time, scars) together is how well the wound stays closed. If you can keep it close with a bandage or tape, it will heal faster and better.
I think what ties these things (healing time, scars) together is how well the wound stays closed. If you can keep it close with a bandage or tape or stitches or staples or glue or whatever, it will heal faster and better. Stitches would be used if a bandage or tape wouldn’t work, keeping in mind how movement would affect it.
Oops. Sorry about that semi-double post (more of a post and a half).
One asks one’s doctor, if s/he hasn’t already volunteered the information.
Incidentally, when I woke up from an operation and found that I’d been stapled shut instead of sewn, my immediate reaction was horror. However, getting those staples removed was less unpleasant than having stitches removed.
Another general Mommy rule is: If it won’t stop bleeding, you go show it to the doctor, and if the doctor says, “That’ll need a couple of stitches,” you get stitches.
So–if it won’t stop bleeding.
Revtim, you’re not sitting there holding portions of your body together with your fingers and a dish towel while letting the Teeming Millions vote on whether you should go down to the Emergency Room and get some stitches, are you?
I’ve had a few cuts that probably required stitches, but have never got them. My bleeding stops pretty quick, and I have never had an infected cut or scrape. I like scars, too. 8^) But if I had a cut that didn’t stop bleeding and/or was too big to hold shut with a bandage, I would get 'em.
If you can’t get to medical care, and you have a deep wound, you may be better packing it open rather than closed. Fill the wound with sterile dressing and leave it covered, but don’t seal the two edges of the wound with a bandage or tape. The problem is that it leaves an enclosed moist area, with oxygen, that can cause some really nasty infections.
You’re better off letting the wound heal from the bottom up, so to speak. If you are near a hospital, this isn’t a problem. But if you are several days from the road, it becomes a serious issue.
On the OP, I’ve had my arm smashed by a rock several hours from the trailhead, so stitches weren’t an option. It left a scar, but no major blood loss or danger of infection. Anyone know after how long is it not recommended to have stitches? I thought it was something like 3 or 4 hours.
I’ve put in lots and lots of stitches (and staples, and steri-strips). During my month in the ER, it was forbidden for any MD to put in uncomplicated sutures – all of this went to the medical students. So forgive me for being a smart-ass.
There are many types of stiching material, many types of actual stitches, and many other factors.
So, something generally requires stitches if it is more than about half an inch long, or if it penetrates quite far.
Some exceptions :
-
If the wound has been open longer than 6 hours, it is not sewn up due to the high possibility of infection.
-
If the wound is from a dog, human, or other animal bite, it is left open.
This is because many subcutaneous infections are caused by anaerobes (that’s what lives in soil and in your mouth). They tend to do really well after you sew something closed tightly.
Stitches also are not meant to pull a wound close. Skin stitches should have as little tension on them as possible. If the wound is large, and goes deep, dermal (under the skin) or muscle sheath (if a muscle is cut) stitches serve to draw the wound close. All skin stitches should do are to draw the edges of the skin in close apposition.
Staples are often used on big wounds (like surgical wounds) and wounds that don’t need to heal pretty (like scalp). They can be placed in a pinch without anesthesia (especially in the scalp). Steri-strips and subcuticular stitches are not used in trauma as they close a wound too tightly – these are commonly used in surgery.
Generally, the protocol for stitching someone up is as follows (as done in the Ben Taub Emergency Center, in Houston, Texas)
-
Irrigate wound with 1 L saline flush, sprayed through the bottle by making holes in the bottle with a needle (like a shower). Test for any nerve/tendon damage before beginning.
-
Clean wound with betadine-soaked gauze * 3 at least. Wait for the iodine to dry before beginning.
-
Place drapes to create a sterile field. Get sterile gloves on.
-
Anesthestize with 2% lidocaine as needed.
-
Place any inverted dermal stitches or muscle belly stitches with 3-0 Vicryl (a dissolvable stitch).
-
Use 3-0 Dermalon for all skin sutures, except on face (4-0 Dermalon, a thinner suture) and eyebrows (4-0 Prolene because it is blue). Place interrupted sutures by halving the wound repeatedly (place first stitch in the middle, then 2 more around it to halve, etc.). Do not close too tightly.
-
Rinse off with more sterile flush, apply topical antibiotic, and cover loosely with 4x4 gauze bandage.
Nope, but thanks for the concern. The question just popped into my head while I was examining a healed up wound on the bottom of my foot. When I originally wounded it weeks ago, I briefly wondered at the time whether or not I should get stitches. I didn’t think so, and I think my choice was correct. Although, it will likely leave a faint scar on the bottom of my foot.
I agree with most of what edwino says (except that I would use chlorhexidene gluconate rather than Betadine, I like to anaesthetize before gloving, and I would use finer sutures on the face) but there are some basic principles that may not be getting through:
-
Sutures are not for stopping bleeding. If the bleeding doesn’t stop, you can tie off the bleeding vessel (if it is large) or cauterize (zap) it if it is small. You never sew up an actively bleeding wound.
-
Sutures are not for preventing infection. In fact, stitches can make infections worse. Part of the treatment for an infected wound that has been sutured is to remove the sutures.
When thinking about suturing a wound you have to think about the chances of infection. You can think of wounds as clean (e.g., wounds the surgeon makes in the operating room, most cuts from sharp knives in the kitchen, etc.) or dirty (bites, cuts from rusty cans when walking barefoot through the dump, etc.). For clean cuts, sutures that hold all tissue layers in place make it possible for the wound to heal by “primary intention” with a minimal scar and over a short time. For dirty wounds, healing will be by “secondary intention” involving at least a low level of infection, granulation tissue, and much more scarring. In these cases the sutures are placed so that they keep all tissue layers more or less in place to minimize scarring and to speed healing but yet are loose enough and spaced far apart enough to allow the wound to drain. (If the scar is bad enough, you can go back later, after it has healed and contracted [at least 6 months later] and do a CLEAN “scar revision.”)
For clean wounds, I would close up any that I thought might leave a bothersome scar. I can’t say how deep or how long the wound would have to be. It depends on the body part. I would not necessarily use sutures. Cyanoacrylate glue (“super glue”) is an alternative as are SteriStrips (if they are put on correctly) and I have had great results using a fairly tight BandAid for clean cuts on fingers.
For dirty wounds, the trick is to close it but not so tight that it can’t drain.
Of course, most wounds are neither “clean” nor “dirty” but somewhere in between and deciding what is best is why doctors and nurses spend a lot of time being trained, why lawyers make a lot of money, and why we (or our employers) pay through the nose.