On Call: Does This Cut Need Stitches?

Imagine this scenario. It’s close to dinnertime and your child has sliced open his finger accidentally while playing. Your regular pediatrician’s office is about to close, and you’re not sure the cut warrants stitches and a trip to the emergency room, where you might encounter a long wait. Read on to help determine how serious the cut is and the best way to properly care for it.

Skin cuts or lacerations are very common in children. Each year, millions of kids suffer from lacerations, and many of them require stitches (sutures) or other methods to help them heal properly. Stitches help keep the wound closed during the healing process and decrease the size of the scar.

Types of Stitches
If the cut is not too deep, skin tape or special glue may be used to close the wound instead of being sewn shut with stitches. But deeper wounds need stitches to hold the edges together for adequate healing. Very shallow cuts may need no special treatment at all, especially if they are less than one inch long and the skin edges are not separated.

Some sutures are dissolvable, so that they do not need to be removed days later. These are mainly used in deep wounds to give more support for the outside skin stitches. They are not usually used on the outside skin because they may increase the risk of a more visible scar.
Sometimes staples are used instead of stitches. Staples are quicker and easier to put in and to remove. They should not be used on the face because they don’t bring the skin edges close enough and may lead to greater scarring. Staples are often used on the scalp, where hair will cover the scar.

Pain Medication and Aftercare
All children should have pain control prior to suturing a wound. For superficial or shallow wounds, a topical anesthetic cream may be sufficient, but an injection of a numbing medication is needed for deeper wounds. Younger children may benefit from sedation prior to the procedure, which involves being given a medication to make him or her drowsy. Sedation has some risks, including stopping breathing, so these risks need to be discussed with your doctor before giving your consent for the procedure.

After the cut is treated, it is usually best to keep it dry for at least 24 hours to give the edges a chance to heal. After that, the area may be cleaned gently with soap and water and allowed to dry. A topical antibiotic once or twice a day may be helpful to decrease the risk of infection. For certain types of wounds with higher risk for infection, your physician might prescribe an oral antibiotic to prevent infection. Keep your child away from activities that could reopen the wound, and use extra sunscreen on the healing area of new skin.
All lacerations will leave scars. How visible the scar is depends on:
• The size and depth of the injury
• Whether it is straight or has irregular borders
• The location of the cut
• Whether the laceration is aligned with natural lines or wrinkles
• How quickly it is cared for
• Whether there is a wound infection
Most lacerations may be treated by a trained emergency physician, or often by a family physician or pediatrician. But some wounds are more complicated and require the care of a plastic surgeon. This may be beneficial if the cut is deep, irregular or dirty and needs treatment in an operating room, or if the area involved is in a cosmetically sensitive area, such as on the face.

What should you do if your child gets a cut?
1. Calm him or her down.
2. Apply pressure to stop the bleeding with a clean cloth or bandage for at least five minutes, without removing the pressure.
3. If the cloth becomes soaked through with blood, put a new cloth on top of it.
4. After the bleeding stops, wash your hands and gently wash the wound area with soap and water without scrubbing it. Let water run over it for several minutes.
5. Cover the wound with gauze or an adhesive bandage.
6. Call your child’s physician, or for severe bleeding call 911 or go to the nearest emergency room.
7. Make sure that your child has had a tetanus vaccine within the past five years, or make sure he or she gets one within 24 hours.

Stitches should be removed when the wound is able to stay together without them. Stitches on the face may be removed after five days, but in areas with higher skin tension like the elbow or knee, they may need to stay in for 10-14 days prior to removal.

Dr. Daniel Neuspiel is a general pediatrician at CMC-Myers Park Pediatrics. He is Director of Ambulatory Pediatrics at Levine Children’s Hospital.