FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

A STITCH IN TIME CAN USUALLY IMPROVE WOUND HEALING

Question: Recently I cut myself while out hunting. The following day, the cut was looking bad so I went to the ER for stitches. They said I should have come in sooner, and it was too late to sew it up. Is this right or was the doctor just being lazy? What are the guidelines for getting stitches?

Answer: Most wounds will heal without stitches, which doctors also sometimes call “sutures.” However, except for small cuts that aren’t very deep, wounds usually heal better when they are closed up with sutures. This is because sutures help to stop the bleeding and promote healing by bringing the ends of the torn tissue together. In most cases, this makes for less scarring and a nicer looking skin surface once healing is complete.

There are some types of wounds we don’t usually sew up. Sometimes this is because a wound has been left open for too long a period of time, giving bacteria a chance to multiply. Even more problematic are wounds that have already become infected or inflamed. Crush injuries where the skin and tissues have been shredded are also often best left “open.”

Additionally, human and animal bites are usually not sutured since these are considered “dirty” wounds. Of course there are exceptions to this rule and the others I’ve mentioned. The number of wounds sustained and their severity can be make suturing of otherwise problematic wounds advisable. Also, if animal or human bites are on the face, your doctor may decide to suture your wound to minimize disfigurement.

As for a timetable for getting a wound sutured, this does vary a good deal depending on the physician and the circumstances. And, in the vast majority of cases, laziness has nothing to do with it. Many physicians believe it’s generally not a good idea to suture any wound over six hours old, because the bacterial count can double within three hours of a cut. On the other hand, some physicians believe that wounds on the body can usually be sutured if under 18 hours old, and they give facial lacerations up to a 24-hour window.

Prompt treatment for any cut should include washing it out, preferably with saline, but water alone is better than not cleaning at all. Placing a clean, dry bandage over the wound will prevent further contamination to the wound. If it is small, and the bleeding stops easily, it may not need sutures.

Even these smaller wounds, however, still need to be watched closely for infections. Cuts and injuries that you get outdoors may be more prone to infection than a cut in a clean house with a clean household item. For instance, a piece of broken glass in the woods can by much more hazardous than a piece of broken glass in your kitchen.

Another reason to have your wound checked early is to evaluate the need for a tetanus shot. The general guideline is to update this shot every 10 years in adults. However, an obviously contaminated wound, a puncture wound, or a severe burn, requires another shot after just five years.

At this juncture, I’d suggest that you go to a family physician to have your wound evaluated. He or she can assess if additional intervention such as antibiotics, a tetanus shot, or a re-opening and late suture of your wound would be appropriate in your case.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.