Needing Stitches?

In most of my blog entries, I discuss how to stay out of the Emergency Department.  However, getting a deep cut that needs stitches is one of those times that it is probably best to bring your kid to the ED.  Here are some good things to know.

What cuts need stitches?  These are cuts that are through the skin where you can see fat inside, cuts that are gaping open, cuts that will leave as wide a scar as the cut itself.  One old wives tale is that if you wait too long, the cut can not be stitched.  This is not true- if you are out fishing, get a cut, and can’t get in before four hours, you can still get stitches and minimize infection and scarring.

Do I need a plastic surgeon?  Many parents wonder about this since so many of kid’s cuts are on their faces.  Kids meet the world with their big and heavy heads, and parents worry that cuts on foreheads, eyebrows, lips, and chins will leave noticeable scars.  It is an old wives tale again that plastic surgeons do some magic with these cuts that ED doctors don’t.  For the vast majority of those cuts, the plastic surgeon would do nothing different than the ED doc- sew it up!  All cuts leave some scar, but most kid scars on faces fade after six months to a year and are barely noticeable.  If the scar ends up looking bad, then it is time to see the plastic surgeon for a “scar revision.”  But again, the plastic surgeon would do nothing different for the first closure.

Will it hurt?  If your ED is really with the times, they will numb the cut with an anesthetic gel- no shots needed!  It takes about three applications over 30-40 minutes.  The gel works great for faces, scalps,  and most limb cuts.  It can not be used for fingers and toes.  Then the cleaning and stitching are painless.   However, fidgety babies and toddlers will still need to hold still for their stitches and may need to be on the velcro “papoose” board.  Then there will often be plenty of screaming because no toddler likes to be trapped.  At least they won’t feel the stitches themselves!  Also, there are no reports of toddlers needing psychotherapy later in life because they were traumatized by the papoose experience.

How do I take care of the stitches?  After stitches are put in, keeping them clean and covered is important to lessen scarring.  Yet another old wives tale (that many doctors believe!) is that stitches should be left out in the open.  In fact, stitches heal faster and with smaller scars if they are cleaned gently once per day with plain soap and water, then covered with over-the-counter antibiotic ointment and a bandage.  No swimming, no long soaks, no peroxide.  Peroxide is best for a one-time, first cleaning of a cut, but after that too much peroxide poisons tissue and slows down healing.

Finally, few cuts with stitches need antibiotics.  If they are cleaned well and on a body place with good blood circulation (faces, scalps), infections are very rare.  The cuts that need antibiotics are those from animal bites, or dirty wounds on limbs.

If you have any questions about the stitching experience, or have a stitching story to share, please comment!

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