Dear Dr. Johnson: How do I know if a cut requires stitches?
Dear Reader: As kids become more active during the warmer spring and summer months, the number of trauma-related injuries increases. Lacerations (cuts or gashes) are some of the most common injuries.
Lacerations are cuts that extend into tissues below the skin surface. They can come from numerous types of falls, bumps, or other sharp objects. The first step after an injury occurs is to try to remain calm and to apply direct pressure to the wound to control bleeding. Firm pressure over the wound in most cases will stop the bleeding. This can be done with gauze or a clean cloth. If the wound is large or severe, immediate medical attention should be sought in the emergency room or by calling 911.
For less severe wounds, it must be determined if they require further medical care. A general rule of thumb for when lacerations should be seen by a physician is if they are deep and over a half-inch in length, gaping in that the two edges don’t stay together on their own, the bleeding does not stop after direct pressure is applied for 5 minutes, or the wound penetrated deep into the tissue. When in doubt, it is best to call your child’s physician or have the child seen as the extent of a laceration in an upset child can be somewhat difficult to determine.
A wound can be closed with various techniques to minimize risk of infection, speed healing, and decrease scar formation. Some ways of closing wounds are sutures (stitches), staples, steristrips (tape), or my personal favorite — glue. Which technique is used depends on the location and extent of the injury. If the wound requires closure, it is best if this is done as soon as possible. Most wounds should not be closed more than six hours after the injury as the risk of infection greatly increases.
If you determine that the laceration does not require stitches or other closure, make sure it is well cleansed. One of the best ways to do this is with running tap water in a sink or bathtub. Don’t soak the area but instead run warm water across the wound. It is not recommended that alcohol, hydrogen peroxide or iodine be used. These can increase discomfort and aren’t necessary. After the area is thoroughly washed, antibiotic ointment can be applied and covered with a sterile dressing (gauze or bandage). Butterfly bandages can also be used to hold the cut edges closed while healing.
All lacerations should be monitored for signs of infection. Increasing redness, swelling or pain can be signs of infection. Other symptoms may include pus drainage, fever or red streaking from the wound. If your child develops any of these, they should be examined so that if an infection has developed, it can be treated.