Have you ever thought or asked, “Does that cut need stitches?” while standing in front
of your ten year old as they were playing soccer on a Saturday afternoon or evening? It seems to always happen when the people who could give you that answer are unavailable. We ,as parents, understand how you feel. Here are a few guidelines to get you through the weekend whenever that question arises.
First, as a provider there are three reasons for suturing lacerations (stitches):
1. In order to stop bleeding when it hasn’t stopped with 15 minutes of holding pressure.
2. When you as you try to stop the bleeding, you have to constantly put the tissue back in place or replace
3. Cosmetics or improved scaring.
As you can see, number 1 and 2 are fairly obvious, in most cases you aren’t even asking that “Does it need …” question.
Here are a few ‘to dos’ whenever this situation arises. First, Flush it with water. While sterile is always preferable, if unavailable use whatever source of drinking water you have. Water from a water bottle will suffice. We’ve even used a garden hose or a kitchen faucet when that was all we had and the laceration was contaminated with dirt and grass. Once it’s clean, put a pressure dressing on it. A pressure dressing is clean gauze rolled up to 1/2 inch or more diameter and placed over the cut. Take elastic tape ( we recommend Elasticon 2 inch tape and gauze, which you can buy this on Amazon or from a local pharmacy store, be a part of your First Aid kit ) and place it on one side of the gauze while stretching it tight to the other side. This provides constant pressure without you having to hold it, and even makes you look like somewhat of a pro. Try not to put it all around an arm or leg, creating a type of tourniquet. This may stop the flow of blood to that area. Once that is done, if the wound is still bleeding, take your child somewhere where they can treat the would and injury i.e. an Emergency department of a hospital or a Minor Emergency Room.
As a side note, if you happen to be the Coach and you decide to send your child back in, knowing it may be a while before the wound is sutured, you may need to arrange another
ride home with someone other than your significant other. In those rare situations, good luck.
The third reason listed for suturing, “cosmetics”, is probably the hardest one to identify and prompts every mom to utter those words to anyone who will listen … “Do you think it needs stitches?”. This question will come regardless of medical training or experience. Cosmetics = face. The edges of the face, eyebrows and chin, are near bones and tend to split open without fail. So frustrating.
If it’s more than a 1/2 inch, is wide open, or you see fat, it will need sutures or at the least a medical adhesive. Medical adhesives make even small lacerations look better. After all, your little girl, future actor, prom queen or president will appreciate it when they’re sixteen.
The last and final question, how long should you wait to have the laceration closed? The answer. Given the rate of blood loss has stopped or slowed, eliminating the first 2 reasons for sutures, and there are no other pressing issues or dangers, it depends. You are always safe if it is under 6 hours. Studies published by the American Academy of Family Physicians show no difference in infection rate if closed under 18 hours for the body, 24 hours for the head. Of course I wouldn’t argue that with the local resident or intern in the Emergency Department.
In summary:
If it obviously looks bad or won’t stop bleeding, take them in. Our approach is that it is ALWAYS BETTER TO BE SAFE THAN TO BE SORRY. Follow your paternal or maternal intuition, and if you have questions we’re here for you. If it’s on the arms or legs and less than 3/4 of an inch, flush it with water, apply a pressure bandage, try some steri-strips when you get home, hopefully that will stop the bleeding. If it is on the face, more than 1/2 inch or gaping, or you see fat, take them in within 6 hours to be sutured or glued with a medical adhesive. Even small lacerations can look better with a little bit of adhesive.
If you follow these guidelines, you wont have to send the Monday morning picture to your provider asking if I thought you should have had it sutured. Of course if you need to, we’re here to help!
Forney Pediatrics
“Your Kids, are our Kids”
