Do I Need Stitches?

Once you decide if it needs stitches, you still have to care for the wound until you can get professional help.

When evaluating a wound to decide if it needs stitches, there are several questions that need to be answered. The first is why you are considering stitches at all. Stitches are used for two reasons.

1. Close a wound to promote healing and discourage infection
2. Reduce scarring

Let's look at the second reason first, to get it out of the way. If the wound is in an area where scarring would be obvious and the wound is deep enough to see the fatty tissue under the skin surface (the subcutaneous tissue), then stitches may be indicated to reduce scarring. Consult a doctor if you are concerned about scarring.

The first reason is more complicated and requires a bit more understanding.

Wounds that cause a break in the skin are called open wounds. These are the types of wounds that may require stitches. Closed wounds do not have a break in the skin and are identified by swelling and bruises.

There are several types of open wounds:

• Lacerations (see image). This is what we are thinking of when we say "cuts." Lacerations are simple breaks in the skin.
• Incisions. Surgical wounds, which are usually made by a scalpel. These are similar to lacerations, but have very smooth edges.
• Punctures. It's hard to tell a puncture from a laceration (see photo) if the item that made the wound is big enough. Lacerations tear through the skin, while punctures go in and come back out. If the item that made the puncture is still imbedded, it's called an impaled object.
• Avulsions. These are torn sections of skin, either a flap open on three sides or torn away completely.
• Abrasions. These are scratches. The difference between an abrasion and an avulsion is the depth. Abrasions leave the skin mostly intact, while avulsions remove the skin entirely.

These are the wounds--and the patients--that should always go to the doctor:

• Diabetic patients with any open wound
• Animal or human bites (remember, we're talking about open wounds)
• Dirt that won't come out of the wound
• Can't close the edges of the wound
• Uncontrolled bleeding - Call 911

Lacerations, punctures, and incisions are all suturable wounds (can be stitched). Avulsions that still have a flap of skin attached may also be suturable. Complete avulsions and abrasions are not suturable, but still my need a doctor if they are serious enough.

To determine if stitches are needed, look at three things:

1. Depth. Is the wound deep enough to see the subcutaneous tissue (yellowish fatty tissue)? If so, the wound is deep enough to get stitches, but still may not need them.
2. Width. Can the wound be pulled closed easily? If the wound is gaping and cannot be easily pinched closed, then it will need stitches to hold it closed long enough to heal correctly.
3. Location. Wounds on areas of the body that stretch and move a lot will need stitches more often than those on areas that do not move as much. For example, a wound on the forearm will not move as much as a wound on the calf, so it would not necessarily require stitches.

The final - but not least - concern is how long it's been since your last tetanus vaccination. A booster tetanus shot is recommended every 10 years, unless you get a dirty wound—in which case some experts recommend getting a booster if it's been more than 5 years.

In general, if it's been more than 10 years since your last tetanus shot, then you should go see a doctor. And while you're there, you might as well have your wound evaluated for stitches. Ultimately, if you're concerned about the wound and unsure whether it needs professional attention, then see a doctor.

Sources:

Achten, J., Parsons, N., Bruce, J., Petrou, S., Tutton, E., & Willett, K. et al. (2015). Protocol for a randomised controlled trial of standard wound management versus negative pressure wound therapy in the treatment of adult patients with an open fracture of the lower limb: UK Wound management of Open Lower Limb Fractures (UK WOLFF). BMJ Open, 5(9), e009087. doi:10.1136/bmjopen-2015-009087

Steen K. [Should traumatic wounds be closed within eight hours?]. Tidsskr Nor Laegeforen. 2014 Sep 16;134(17):1657-60. doi: 10.4045/tidsskr.13.1551. eCollection 2014 Sep 16. Review. Norwegian.