Do I Need Stitches for This Wound?

Uses of Sutures

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Stitches are used for two reasons:

• To close a wound to promote healing and discourage infection
• To 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. Review the types of wounds, how they are treated, and possible infections.

Types of Wounds

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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: This is what we are thinking of when we say "cuts." Lacerations are simple breaks in the skin.
• Incisions: Incisions are 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 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 that is 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.

When to See the Doctor

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These are the wounds that should always be seen by a doctor:

• Any open wound in a person with diabetes
• 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

Can It Be Stitched?

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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 may need a doctor if they are serious enough.

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

• 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.
• 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.
• 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.

Tetanus Immunization Status

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 five years.

Ultimately, if you're concerned about the wound and unsure whether it needs professional attention, then see a doctor.