The care and feeding of stitches

Factual Questions
1

My daughter got six stitches on her wrist last night (awkward 13 year olds and fancy stemware do not mix). The ER surgeon’s instructions were: Keep it covered. Do not get it wet. Have her pediatrician remove stitches in 7 days. The wound care nurse’s written instructions are: Keep it covered for 24 hours, after which stitches should be washed with warm soapy water and left uncovered during the day. Have stitches removed in 5 days.

Which to follow? Why the conflicting instructions? What to do if bleeding starts again? It did during the night and compression stopped it. It continues to bleed on and off, but not heavily.

For now I’m following the ER surgeon’s instructions, mostly because my daughter is not about to let anyone near enough to wash it. But I’m curious as to the different schools of thought that give such contradictory instructions.

2

Just so the moderator doesn’t get all het up about practicing medicine without a license: call your daughter’s pediatrician or your regular doc and ask. That said: My opinion: 7 days isn’t too long, but I’ve never heard of keeping stitches covered that long, correct about not getting them wet. As for the conflicting advice - how long is a judgment call. (I do have some experience with stitches – staple sutures after my back operation, regular sutures in my cut hand (which I removed myself), sutures in my son’s lip, staple sutures after my s.o.'s neck surgery). My s.o. was told to keep the bandage on if it was still bleeding, which it did a little bit for a few days. But the staples were loosening up after 4-5 days and I removed several myself. (I’d have removed them all if I’d had the right instrument - staples are a little trickier.) When he went back to his surgeon 9 days later, I went with him and the surgeon was not at all put off that I’d removed some but most doctors like to think anything they do is complicated business that lay people can’t possibly deal with. So, 7 days, 5 days, no big deal - if it’s healed properly and looks fine, 5 days should be enough. Let your regular doc make the call. Keep bandage on if bleeding, otherwise remove it; don’t get them wet.

3

Just to clarify.

My daughter has seen a doctor. My daughter’s pediatrician’s office has been contacted. I have written instructions on the care of the stitches. I was just wondering about the conflicting instructions I received.

Why one source tells me to wash while the other says do not wet. One source says keep covered and the other says uncover during the day.

What are the different reasons for the different instructions?

4

The last time I had stitches, the care instructions I received from the doctor were similar to those given to you by the nurse.

How severe was the cut? Being that the first person you spoke to was a surgeon, his/her first instinct could have been to treat the wound as a surgical incision rather than a deep cut.

5

All this inwardly hysterical mother saw was gallons of blood and mounds of white tissue. The laceration was 1 and 1/2 inches long, according to the emergency room papers I have.

I’ve had surgical stitches, which I was told to keep dry.

Why would one keep surgical stitches dry, yet wash a deep cut? Why would you cover, or not cover, a wound? These are the questions that keep this teeming 1/1000000th awake at night.

6

WAG
Covered at night to keep it from snagging on the bed clothes
and uncovered during the day to let it air out? They tend to weep some for several days, and if you trap in the moisture it will get, well, yucky.
I don’t think there is much different between 5 days and 7 days. Five days is enough, if the wound appears to be healing. However, a couple more may be in order if the wound wasn’t really clean, or was kept from drying out.
Once again, these are my WAGs and IANAD.

7

Welcome to the wonderful profession of medicine

For the last 200 years medicine has been practiced “I was taught this way, so this is the way I am going to do it.”

during the last about 20 or so, medicine as a whole has decided that maybe we need some scientific data to prove what we are doing is actually helping.

A great example of this is bee stings. We were always taught that they need to be scraped out, and not to squeeze the stinger in fear of injecting more toxin. A test in England has proven that fear to not be true. Yet the idea of just getting the stingers out is still not widely accepted.

So in short, medicine is still a great art of opinon, and is much less of a science than it should be

8

The instructions are conflicting because there is no single correct answer.

Have you ever bought at tree at a nursery and asked for planting instructions? If so, I am sure you noticed that the instructions you got conflicted with what you read in a garden book or heard on the radio. There isn’t just one correct answer.

As for wet versus dry: I remember very well being greatly disappointed many years ago when, during a summer in San Diego, I was told by a surgeon that I couldn’t get my stitches wet. It’s not much fun to spend every day at the beach and not be able to go into the water. Many years later I was very pleased to read a scientific report of a study that found that sutured lacerations healed just as well in people told that they COULD get them wet as in people told that they must keep them dry. Since then I let mine get wet and have noticed no ill effects.

I think the reason for the conflicting instructions are based on theory: If it is a clean and uninfected wound (which most drinking glass wounds tend to be), keeping it dry should help keep it from getting infected since bacteria won’t be washed into the wound. On the other hand, if it is infected or not clean (e.g., smeared with blood), washing it will keep it clean and help keep it from getting infected. If it is going to get infected, it is likely to get infected in the first day or two, hence the instructions to keep it dry for 24 hours then wash it.

As for how long to leave the sutures in: The longer you leave them in the less chance that, once taken out, the wound will open up again and eventually heal leaving a big scar. On the other hand, the longer you leave them in, the greater chance that the sutures themselves will leave a mark so that the scar looks like +++++++ instead of ------.
How long they should be left in depends on how much stress the wound is likely to be subject to and how important it is to minimize the scarring. It also depends on how big the sutures are and how many there are. Two tricks that I think are often worthwile: 1. Remove the sutures in stages (e.g., remove every other one on day 5 and the remainder on day 7), 2. As you remove the sutures, replace them with SteriStrips or a similar product to hold the wound edges together.

I can’t give you medical advice but I can tell you what I think makes sense and works for me for most lacerations: Cover clean, sutured wound with small amount of antibacterial cream or ointment (the antibacterials don’t really do anything, but the goo helps keep the sutures from sticking to the dressing). Cover with a few layers of cotton guaze (e.g., 2 x 2 squares). Keep in place with gentle pressure (e.g., paper tape or elastic dressing). Keep dry for 24 hours. Then keep dry except allow to get soaked once each day preferably while bathing. Discard the soaked dressing after bathing and replace with a clean one. (This is the wet-to-dry method of keeping a wound clean. The wet dressing removes old blood and crud from the wound surface without much pain or stress on the sutures.)

Of course, no matter how you care for a wound, it can get infected and if there are any signs of infection you need to get the wound evaluated by a physician.

9

I couldn’t find a randomized controlled trial of wet versus dry but here is the abstract of a report by Drs. JM Noe and M Keller of the Department of Surgery (Plastic) at Beth Israel Hospital in Brookline MA:
“This study was performed to answer the question of whether or not a patient can wet stitches after a minor soft-tissue surgical procedure without increasing the incidence of infection or disruption of the wound. One hundred consecutive patients underwent an excision of a skin or soft-tissue lesion closed either primarily or with a local flap. Monofilament nylon was used. There were 55 benign lesions and 45 malignant lesions. All procedures were performed using local anesthesia on an ambulatory basis. All patients were asked to wash the wounds with soap and water twice a day starting the morning after surgery. All wounds healed without any infections and without any disruption or dehiscence of the wounds.” The full study, “Can stitches get wet?” appears in Plast Reconstr Surg 1988 Jan;81(1):82-4.

10

You keep the stitches covered snugly and basically dry for the first two days. This is because the wound needs to begin healing and stitches, if wet, tend to allow any stray bacteria to travel along them into the wound.

By the third day, the incision line will have begun to knit up pretty tightly, usually forming a thin crust. Change the bandage if you choose and replace with a dry sterile one – careful! don’t put your dirty fingers on the sterile side!

Should the dressing get wet, change it immediately, swab the stitches with an antibiotic solution call betadine soap – found in all drug stores. It looks yucky, being iodine based, but it kills everything. Surgeons use it for surgical preps. Don’t bother rinsing, just pat dry with sterile pad and redress wound. Watch for any sign of infection afterwards.

You could swab the stitches with hydrogen peroxide, which fizzes and tingles and will impress your kid and kill any germs, or swab with alcohol if they get wet.

If the dressing is too tight, change it or cut the tape, loosen it up and retape. It will weep for a couple of days for the suture line will not heal all at once, but in irregular spots. Unless she pours out blood, don’t panic.

BTW, it’s probably going to look nasty when you see it, dried blood and bruising and all, but don’t sweat it. That’s normal. A whole lot of angry redness or oozing pus is not. Any signs of that and whisk her on into the doc.

I’ve had stitches several times, being not the most graceful person, some I just plucked out on my own, some I slathered betadine on, some I had to clean with peroxide and most I let the doc remove.

BTW, some sting a bit when they come out, most do not.

11

“As for wet versus dry: I remember very well being greatly disappointed many years ago when, during a summer in San Diego, I was told by a surgeon that I couldn’t get my stitches wet. It’s not much fun to spend every day at the beach and not be able to go into the water. Many years later I was very pleased to read a scientific report of a study that found that sutured lacerations healed just as well in people told that they COULD get them wet as in people told that they must keep them dry. Since then I let mine get wet and have noticed no ill effects.”

Two words that may have caused the surgeon to give the advice he did despite the fact that getting the stitches wet normally isn’t a problem: salt water. :eek:

12

" Keep it covered. Do not get it wet. Have her
pediatrician remove stitches in 7 days. The wound care nurse’s written instructions are: Keep it
covered for 24 hours, after which stitches should be washed with warm soapy water and left
uncovered during the day. Have stitches removed in 5 days."

That doesn’t seem very conflicting. Maybe some variance, but its pretty minor.

You didn’t even tell us what type of stiches they are & what material, so I can’t really say anything more.

13

Handy, how can “keep it covered and dry” not be in conflict with “keep it covered only at night and wash it”?

14

I recently had wrist surgery performed by an Orthopedic Surgeon. He listed a series of rules I was to follow over the next few weeks to ensure proper healing. This being my first suregery, I wanted to know the how’s and why’s. It boiled down to this… You don’t want to immerse a wound in water because that can potentially introduce infectious agents. Immerse is the key word. It will probably be fine to wash the wound, but do not immerse it. Waiting 5 or 7 days is just a guideline. Once the skin has healed enough to cover the wound, it’s safe to wash. There’s little chance of infection if you’re regularly changing the sterile bandages. The skin around the wound was probably disinfected with Bactene before surgery, and will be safe enough for a few days. Of course, these were his responses to my specific questions, YMMV, consult your physician, etc…

The bottom line is that surgical medicine is more Art than Science. Nothing’s exact, so the surgeon’s tend to be conservative, and give slightly exaggerated instructions. Rather than say “don’t immerse the wound”, they’ll say “don’t get it wet”. If the average small wound takes x days to close, they’ll add 2 or 3 days to be on the safe side. Most of the time, infection will be your biggest worry after the operation.

On another note, to reduce scarring, pick up a small bottle of Vitamin E … NOT Vitamin E lotion … and massage it into the wound once it’s sufficiently healed. It’s worked wonders for me. Additionally, perform wrist exercises to ensure that full mobility is restored. A couple minutes a day will do, but don’t do anything that hurts.

15

I think previous posters have it when they’ve said medicine is not as exact as we’d like to believe. I work in a hospital lab and just about every physician wants his orders done in a different way but not many of them can say why when I ask. For most it’s because “that’s the way I learned it”.

That said I’ll just toss my nickel into the pot. I had a fairly messy accident once that resulted in 60 stitches in my scalp and forehead. I was told that I could wash my hair after about 24 hours and to definitely not cover the wound at all. It had to be thoroughly irrigated to get rid of foreign debris before it was sewn up. It oozed blood for a little while afterward but I just blotted with dry gauze. Half the stitches were removed after three days I think and the rest were taken out two or three days later. About ten stitches were internal and just eventually dissolved.

Oh, I should add that although I resembled a Frankenstein creation for a while I look (mostly) normal now. :slight_smile:

16

Biggirl, did you get an answer from the doc yet?

“Handy, how can “keep it covered and dry” not be in conflict with “keep it covered only at night
and wash it”?”
Dry means don’t take a shower.

Wash means a very light cleaning with a slightly wet cloth.

As for keep it covered, that’s just there way of saying don’t get it dirty. It does need air to cure you know?

17

“It does need air to cure you know?”

This is not true. There is now a large body of research showing that wounds heal better when not allowed to dry out.

However, in the case of sutured laceration, all the healing is going on below the surface of the skin where it is nice and moist.

18

She had to wash it last night. It was just icky. There was old dried blood and that clear oozy stuff (not pus, it wasn’t evil smelling and wasn’t colored) that could be seen through the bandage.

Thanks to this board (I mentioned the written instructions I had did not give much detail) I washed it with a sterile guaze then patted it dry with another sterile guaze. We recovered it because my daughter did not feel comfortable with the stitches uncovered.

We go to the pediatrician on Thursday. Thanks guys. We’ll not tell my family about my hidden hysteria and the SDMB’s part in keeping me calm.

19

The “rules” for stitch care depend on who you ask. Both sets of instructions would be fine. The length of time you leave the stitches in depends on the location of the wound… on the face, scarring is less accepttable so stitches are taken out sooner. But the difference between 5 and 7 days is not realy significant.