Does my child need stitches for a cut?

The Pediatric Insider

© 2013 Roy Benaroch, MD

A question from Mark: “How can I tell if a wound needs sutures or stitches? It doesn’t look that bad, and I don’t want to go to the ER!”

First, it turns out that ER-type people don’t like to call it the ER. It’s an emergency Department, not a Room. ED is the place you go in the hospital. ER is a TV show.

And medical types don’t really call them stitches. They’re sutures.

Anyway: When in doubt, you need to have someone qualified actually look at the wound. I’ll try to come up with some general ideas here, but when it doubt, call or go see your own doctor.

There are a few reasons that some wounds really need to be treated by medical professionals. The first one is: can you get it really clean yourself? If there’s a lot of dirt or yuck in a wound, or a twig sticking out or something, you really need to go get it cleaned out to prevent infection. At home, the best way to do that is with tap water under pressure. Just spray it, and use a lot of water. But if that’s not practical or possible because of the size or position or kind of wound, go get it cleaned out for real where they know what they’re doing.

If your child has a significant wound and isn’t up-to-date on tetanus vaccine, that needs to be given ASAP, preferably within 48 hours. Tetanus itself is a very serious illness that has is difficult to treat and will keep your child in the intensive care unit for weeks or months. Do not fool with tetanus.

Next question: has the bleeding stopped? Persistent bleeding means the wound needs to be closed. If it’s bleeding a lot, it needs to be seen right away; but even persistent oozing needs evaluation. If the wound stops bleeding, but keeps re-opening (say, because it’s over a joint that bends), that probably needs to be closed, too.

Finally, there are cosmetic questions. A wound that’s closed either with sutures or with other methods that hold the edges close together during healing is going to end up with a less-prominent scar. That may not be important, say, on the back of the scalp; but certainly on the face, most parents want minimal scarring.

There are some specific wounds that end up leaving more noticeable scars than people expect. Vertical scars on the cheeks or forehead really stand out; and even a small scar on the edge of the lip that extends from the lip onto the skin can leave a sort of “step-off” shape.

If you do think a wound may need closure, you need to get it seen right away. After twelve hours or so, the risk of infection from sutures rises, and “delayed closure” after this time can lead to problems. The longer the time after twelve hours, the worse the risk of suturing becomes. Whether you should go to the ED, urgent care, or to your doctor’s office depends on local resources and your doctor’s policies—when you’re not sure, call your doctor’s office first.

Who should place the sutures? Again, I can’t answer that without seeing the wound. People sometimes think that the most cosmetically critical wounds (ie the one on their child) require the expertise of a plastic surgeon—but keep in mind that local availability is going to dictate who actually shows up to do the suturing. In some centers you may end up with a very junior plastic surgery resident who’s actually done far less suturing than the ED physician. On the other hand, if you’re getting a vibe that the ED physician may not be comfortable closing a wound, you should certainly speak up. Ideally, deciding on whether calling plastics is needed should be a collaborative decision between the parents and ED doc. It never hurts to ask the ED doc’s opinion.

And no matter who does the suturing, no one can guarantee a small scar. It just doesn’t work like that. Different people heal differently, and a great cleanout and perfect suture technique is still no guarantee.

What if you end up with a scar that’s really prominent, because you decided not to get sutures or because that’s the way the wound healed? You can always take your child to a plastic surgeon afterwards, typically six months later after the scar has matured, to talk about “revising” the wound.

Earlier: What to do with a bleeding child, including more about first aid for bleeding, different ways of closing wounds, and how to take care of sutures after they’re placed.

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3 Comments on “Does my child need stitches for a cut?”

  1. Great post! In our area the plastic surgeons don’t routinely go to the ED to suture a wound. They say they get better results if the wound heals (after suturing by someone else) and repair it later in a controlled setting (operating room or their office, depending on wound and age of patient). I guess the argument makes sense since it would then be a surgically made cut from which they can better approximate the edges (ie make it look better in the end). Part of me still thinks they just don’t want to go to the ED.


  2. ReadingMom Says:

    Could you add a few comments about dermabond? When, and where (on the body) it’s appropriate? Is the scarring similar to sutures? Should I always just defer to the judgement of the ED physician?

    Thank you!


  3. Dr. Roy Says:

    Dermabond is a brand name of a “medical glue” that can be used to close some lacerations. It looks and smells like superglue, and is painted on with a little applicator. I believe there are other brands of a similar glue available now.

    The advantages of glue are that it’s non-distressing and doesn’t have to be removed later. If it’s applied perfectly, the scar can be minimal. However, glue isn’t very strong. You can’t use it to close a wound that gapes open, or a wound that’s across or near a joint that moves. Lacerations over the chin tend to open up too much for gluing, and lacerations on the scalp can’t be glued because of the hair that gets in the way. I’m also nervous about using it near eyes, because some might drip in. You also have to be be sure a glued wound is very, very clean– they may be more apt to get infected than a sutured wound.

    Another option for closure is staples. These are great for scalp wounds– you can get them in quick, and they hold well. But they scar more than sutures.

    The bottom line is to discuss options w/ the doctor. Yes, you should usually go with what the doc feels most comfortable with. If he or she says glue isn’t a good idea, I wouldn’t push it.

    Liked by 1 person

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