Do You Know if You Need Stitches? Here’s Help

It’s tricky to tell whether a cut or scrape needs a doctor’s attention.

Everyone gets skinned knees, small cuts, puncture wounds or animal scratches once in awhile.

And many minor lacerations heal without medical intervention. But some injuries require stitches or other types of treatment to ensure proper healing.

An adult’s cut or a child’s injury may warrant a visit to an emergency department, but how do you tell?

“It can be difficult to tell if an injury will require stitches or not,” says Purva Grover, MD, Medical Director of Cleveland Clinic Children’s Pediatric Emergency Departments. “It’s really a judgment call and a challenge, I think, for most people to ascertain the difference.”

She says that cuts and puncture wounds upset parents greatly and it’s better to seek immediate medical attention if you’re uncertain how serious the injury is.

Signs a cut requires an emergency department visit

“Certain lacerations and wounds almost always require a visit to the ER or urgent care center,” says emergency physician Baruch Fertel, MD. He advises heading to an ER for evaluation if the wound is:

• Deep enough to expose the dermis or yellow subcutaneous fatty tissue
• Gaping open so that you can’t easily use gentle pressure to press the edges together
• Located on or across a joint (You may also have damaged nerves, tendons, or ligaments.)
• The result of an animal or human bite (You may need a tetanus booster shot or oral antibiotics, as well as stitches.)
• A result of a foreign object impaling the area
• Made by a high-pressure impact from a projectile like a bullet
• Contaminated or resulting from a very dirty or rusty object
• Bleeding profusely (and flow does not appear to slow)
• On a cosmetically significant area, such as the face
• On or near the genitalia

If you decide to go to the emergency room or urgent care center, here’s what you need to know: 

1. Leave foreign objects alone 

Do not remove any foreign object — such as a stick or piece of metal — stuck in the wound, says Dr. Fertel.

“You don’t know what the foreign object has struck underneath,” he says. “More than once, I’ve seen cases where the object has struck an artery and is blocking the bleeding. The moment you pull it out, there’s no longer anything there to block the arterial blood flow and this can cause devastating consequences.”

2. Bites and dirty wounds need special treatment

If an animal or human has bitten you or a family member or friend and the laceration is more than a very superficial abrasion — or a contaminated or rusty object caused the injury — seek medical attention immediately.

For adults, if you haven’t had a tetanus booster shot within the past 10 years, you’ll need one now.

Most children have had tetanus vaccinations, but these types of injuries require medical evaluation anyway. The attending physician may prescribe oral antibiotics as well.

3. Clean the wound if you can

If possible, gently clean the injured area before visiting the emergency department by thoroughly irrigating it.

Dr. Fertel suggests using tap water and a dilute liquid antibacterial soap to do this. This is a good way to clean off almost any wound.

He says hydrogen peroxide does not work well for wound cleaning. It damages the tissue.

“One of the best things parents can do before bringing their injured child to the ER is clean the wound, but only if they have the time and expertise to do so,” says Dr. Grover.

4. In case of stitches, avoid food and drink

Dr. Grover advises parents to avoid giving an injured child anything to eat or drink before going to the ER.

“We may need to give the child sedation medication before suturing because most children will not stay still during the process. If they’ve had a drink or eaten anything, this can delay treatment,” she explains.

5. Apply direct pressure and elevate

On the way to the hospital or clinic, apply direct pressure and elevate the injured area.

This will usually help slow or stop most bleeding. Most of all remain calm and drive safely. You wouldn’t want to complicate the situation by getting stopped for speeding, or, even worse, an accident.

If your cut or scrape is very minor — not deep or contaminated — treat it at home by irrigating it as suggested above, then dress it with a topical antibiotic and a bandage.

“I don’t encourage people to use Steri-Strips™ at home, Dr. Grover says. “If a wound is large enough to require Steri-Strips™, then it’s probably large enough to require sutures.”

Both doctors recommend keeping the area clean and reapplying antibiotic ointment and a bandage several times a day when caring for a minor cut at home.

Keep a close eye on your wound to monitor healing. If you become concerned, visit your doctor right away.

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