The Scoop on Stitches
“If your child has a wound that breaks through the skin and is gaping open, that’s usually an indicator that the wound is going to need professional repair,” explains Dr. Cory Showalter.
Summer is the season for enthusiastic outdoor play, activities that can set the stage for cuts and scrapes. Often, they can be remedied with some cleaning, antibiotic ointment and a bandage. But when does an injury require more involved medical attention? And what’s typically involved?
“If your child has a wound that breaks through the skin and is gaping open, that’s usually an indicator that the wound is going to need professional repair,” explains Cory Showalter, MD, Medical Director of Pediatric Emergency Medicine at Riley Hospital for Children at Indiana University Health. “This may be done with stitches, staples or Dermabond – a glue that closes the wound, depending on the location of the wound and its size.”
It is important to have an expert decide the best option to employ as there are benefits and drawbacks to each method. All three options are designed with the same goal – close the wound safely so that it can heal with minimal scarring. However, Dermabond, for instance cannot be used in an area with frequent movement or the wound could reopen, risking infection, shares Dr. Showalter. Stitches on the scalp require shaving a portion of hair, he says, so it’s often better to use staples.
For some wounds, absorbable sutures, which break down in the body and do not need to be removed, are used. These sutures can be used in many situations, and are often placed in deep wounds with another layer, such as removable sutures, staples or Dermabond on top. While the advantage is a scar without visible stitching, they don’t always absorb as quickly as the family would like, which can cause the child to feel the stitches under their skin. This often leads to a child rubbing the wound, potentially causing infection.
That said, Dr. Showalter cautions against waiting to get the wound repaired. The risk of infection and a less ideal of cosmetic outcome occur if you wait more than 12 or 24 hours to suture the wound, he says. By that time, the wound has already begun to heal internally and this can put the child at risk for developing an abscess or infection when sutures are ultimately applied. The wound will also not close as well once time has passed, he says, creating a larger scar.
“However, not every wound requires a visit to the emergency room,” Dr. Showalter clarifies. “Your pediatrician can take care of a lot of these injuries. If you are not worried about a life-threatening injury, a broken bone or a head injury, then call your pediatrician or go to urgent care. Most are capable of repairing minor lacerations.”
But, if your child requires sedation so they can tolerate the procedure, then it is best to visit the emergency room, as pediatricians don’t often offer sedation. Determining what your child may need is based on both their personality and the severity of the injury. For very deep wounds, a plastic surgeon or even the operating room may need to do the repair, which often requires sedation.
“Here at Riley, for instance, we offer patients a topical anesthetic, called LET gel, which isn’t available most places,” Dr. Showalter describes. “Rather than injecting the wound with anesthetic, we apply a gel, so no needle or pain is involved. Twenty minutes later the area is numb and we apply the stitches. A lot of times, it’s not the stitches that’s the worst part, it’s the numbing injection.”
However, when a child arrives at Riley, they are seen immediately and the numbing gel is applied. While waiting for it to work, a child-life specialist talks to the family, provides individualized care, explains what to expect and distracts the child. The procedure only lasts a few minutes and then the patient and family are sent home with instructions for how to care for the wound, which usually involves applying a topical antibiotic several times a day.
Afterwards, infection avoidance is key. “Infection is a risk in any wound, as your skin acts as a barrier to keep bacteria and germs from invading,” Dr. Showalter explains. “Any break in the skin opens the door to the bacteria. Large, deep wounds, dirty wounds – that may have occurred while playing in dirt or from an animal bite, or puncture wounds – think of stepping on a dirty nail, can increase the risk of infection. A delay in cleaning or repair, or an improper repair can also increase infection risk.”
The length of time sutures typically remain in the body can vary. For example, sutures to the face should only be kept in place for 4-5 days while sutures to the arms or legs should be left in place for 10-14 days. Once ready for removal, patients can usually visit their pediatrician to get sutures removed – a second emergency department visit is not necessary.
“It is important to return to get sutures removed when asked,” Dr. Showalter cautions. “If don’t you return when you should, then it can result in a more painful removal and a less desirable scar.”
-- By Gia Miller