Hey…Stitch This!

This week’s guest columnist is Dr. Frank Betanski, a Family Practice resident at the University Health Center here in Lafayette.

“OUCH!!” (ou-ch); exclamation; a four-letter word indicating urgency and anxiety when children get a cut.  It raises questions with parents that are often confusing and overwhelming: “Does this need stitches?”  ”Should I go to the ER?”  ”Oh Lord, what is THAT??!!”  My mother faced these questions when I returned home from the movie “Edward Scissorhands.”  I grabbed the cutlery and literally started running with scissors.  So let’s discuss the how-to’s (and don’ts) of skin injuries.

First, some terminology:

-Laceration: tear into the skin with blunt force.

-Avulsion: A chunk of skin is removed, exposing a hole in the tissue.

-Puncture: stab through the skin

-Incision: laceration made with a sharp-edged object (knife, glass, scalpel, etc)

You’re thinking: “Thanks for the vocab lesson, doc, but what to do right now with all this bleeding?”  FIrst, apply pressure to the wound with a clean cloth or bandage.  Pressing for several minutes will stop most bleeding.  Remember, constantly lifting pressure to check if the bleeding has stopped will just prolong the bleeding.  Be patient, hold that wound for a good five minutes before checking.  If the cloth becomes soaked with blood, put a new cloth on top of the old one.  Should the bleeding not stop, head to the ER.

Once bleeding has stopped, wash your hands and remove dirt by running water over the wound.  Don¨t scrub the wound yet.  The old faithful hydrogen peroxide can help clean. Peroxide kills germs and can “bubble up” dirt and dead skin.  Only use peroxide once. Multiple uses can poison good tissue and delay healing.  Soaking open wounds in a mix of water and betadine also kills germs. If there is no more bleeding for áwhile, then you can gently scrub the wound with a washcloth if ít has embedded debris.

We see a variety of lacerations in the Emergency Department, and a variety of parental questions about management.  Sometimes the child has a tiny scrape the size of an eyelash, with Dad asking if we should call plastic surgery.  At the other extreme, the kid comes in with a mangled hand that looks like it was attacked by a bulldozer, with Mom wondering if it needs a bandaid.

So when should you bring your child in?  Here are some examples: heavy bleeding that doesn´t stop after 5 to 10 minutes of direct pressure.  Deep (down to fat or muscle layers) and/or longer than one inch.  Large, gaping cuts on the face.  Animal or human bites that break the skin.  Dirty wounds that you can’t get all the debris out. Signs of infection like increased pain, spreading redness, swelling, or drainage.

Many wounds heal themselves without stitches, and sometimes doctors prefer to leave wounds open to heal “from the bottom up.”  For example, we don´t stitch most animal bites, so that the stitches don’t trap infection inside the wound.  We stitch cuts mainly to minimize scarring and improve how the scar will look. Stitching wounds also can stop bleeding, increase scar strength, heal cuts faster, and decrease pain.  Face and forehead wounds can particularly need stitches for the best cosmetic result.  On the other hand, cuts inside the mouth and on the tongue, even deep ones, rarely need stitches. The inside of the mouth heals miraculously, closing big wounds in a few days.

We have many methods to close wounds: stitches (a.k.a. sutures), medical glue, staples, steri-strips (sterile tape).  Glue is good for clean, no-tension incisions.  If the wound cannot be easily closed by gently pushing the edges together, or has shaggy edges, then stitches are better.  Staples are best for areas where scarring is not an issue (inside hair lines). By the way, don’t remove medical staples yourself with an office staple remover.  Paper and medical staples are different animals.  Been there, saw that, saw the scar….

When in doubt, call your doctor, or maybe even send a picture from your phone.  Doctors can often tell you over the phone if a wound needs stitches, but sometimes we just gotta see it for ourselves, to know if we need to…Stitch This!

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