Does your cut need stitches?

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Minor cuts and abrasions are pretty common, but how do you know if your cut needs stitches? Often this is a patient’s biggest question when they come to the ER. It helps to quickly receive medical care as this can reduce your risk of infection and ensure that the cut will heal.

Signs that a cut needs medical attention

  • If there’s significant bleeding or the wound is gaping and open. 
  • If it’s deeper than a scratch and you can see tissue underneath. 
  • If it’s a large laceration longer than 1-2 inches. • If there’s a tendon exposed or nerve damage — for example, if you can’t move a finger. 
  • If you have a laceration and there’s a risk of a foreign body under the skin (such as a sliver). 
  • If you’ve stepped on glass, a needle, or any sharp object.

The cut or wound should be examined within seven hours. Patients who wait longer are at risk of developing a skin infection. If you wait too long to receive care, and particularly if there’s concern about infection, such as a dog bite, the physician might want to do what’s called a “delayed closure.” That means waiting 1-2 days before closing the wound, allowing the potential infection to drain. Otherwise, if infection sets in, a skin abscess will develop beneath the closed wound.

What should I do before going to the ER?

The most critical thing to do is apply pressure to get the bleeding to stop (or slow down). You can simply use your hand to apply pressure, placing gauze or a clean cloth between the wound and your hand. An ice pack is also helpful to stop the bleeding.

If the bleeding is controlled, run the cut under water. “Dilution is the solution to pollution,” meaning that if you run water over a cut, it will dilute the concentration of bacteria and dirt. This is the most effective action you can take to prevent infection. There’s no need to use hydrogen peroxide, as it hasn’t shown to be any better than water.

Another important tip: If you’ve lost a finger or part of a finger, such as a fat pad on your fingertip — save it and bring it with you to the ER. The skin can be used as a “biopatch” to help the wound heal. I recommend gently rinsing it, wrapping it in gauze, and then gathering two Ziploc bags. Place it into the first bag and then take the other bag and put some ice into it. Place the bag with the skin inside the bag with the ice, as the cooling gives a better chance of tissue survival. Avoid directly applying ice to the tissue.

What cuts are most prone to infection?

Some of the worst cuts are from animals, including dogs, and even human bites. If you get into a fight and are cut by a person’s teeth or even your own teeth, this wound is considered highly prone to infection.

Certain parts of the body are also more prone to infection. When on the hands, a laceration — which is a deep cut or tear with two separate edges of skin — is at higher risk of infection. The face and scalp are less prone.

Some patients are more susceptible to infection, including diabetic or immunosuppressed individuals who have had organ transplants or chemotherapy treatment, or those using steroids for conditions like rheumatoid arthritis.

How will the wound or cut be treated?

An ER physician has a few options. If your child is injured, taking him/her to the ER gives you the option of sedation during treatment. We can also check for related injuries or fractures related to the trauma. Below are common wound closure techniques used in the emergency room:

  • Stitches (also called sutures): These can be used anywhere on the body. 
  • Medical skin glue or medical adhesive (Dermabond): This is great for kids as there is little to no pain. However, use is limited to wounds 1-2 centimeters in length on body regions with very little movement or tension. Dermabond is commonly use on small facial laceration. 
  • Staples: These are commonly used on the scalp. They can cause scarring, so it’s preferred to hide them above the hairline. 
  • Steri-Strips: These are often used for elderly skin tears.

An ER physician can help determine what medical attention you need. Many simple lacerations can be effectively managed in a primary care provider’s office or an acute care clinic. If there is any question, seeking treatment in the ER can lead to the best outcome with the least amount of scarring and risk of infection.