I wonder if any of us avoid lacerations over the course of our lives. It seems that everyone I know or every patient I have cared for has a scar and a story to accompany it. Fortunately, it’s not as simple (or complicated) as going to the emergency room and getting stitches when a cut (laceration) occurs. Today’s Straight, No Chaser offers you simple facts and questions to ask your physician when you find yourself or someone else you’re caring for needing care for a laceration. Believe me, you want to know the correct questions to ask, and you want to have an understanding of expected outcomes.
When should I deal with these cuts at home?
Remember that a laceration is a manual breakdown of the body’s most basic defense against toxins and other agents entering your body. This creates a significant risk for subsequent infection. In most cases it is advisable to get a laceration at least evaluated, which doesn’t mean you’ll necessarily need stitches.
Are there things I can do at home to help?
We now know that tap water is as effective as the saline used in hospital or clinic settings to clean wounds. If you’re at home, copious rinsing of the wounds with warm water followed by applying clean wrappings is a good idea.
Are there things I shouldn’t do at home in an attempt to help?
Detergents, hydrogen peroxide and povidone-iodine solutions should be avoided, as they can damage the integrity of the skin.
How long after a cut can I get stitches?
This depend on the location of the wound, your health and factors such as mechanism, contamination and risk for subsequent infection. As a rule, you should get lacerations evaluated within 12 hours after the injury. Under all circumstances you should be seen within 24 hours after an injury.
What happens if I come in too late to get stitches?
Depending on circumstances, your physician has additional options that can reduce the infection risk and optimize the cosmetic outcome. Some older wounds may be loosely closed, followed by a definitive repair in a few days if all goes well (i.e. no signs of infection in the interim). Other wounds may be packed with protective gauze as an alternative. Still others will simply need to heal on its own. Your physician can discuss when and why each option is preferable.
Will I always need stitches?
No. Sometimes what appears to be a cut is actually a scratch. Other times, lacerations can or need to be repaired with other options, such as steri-strips (a version of medical taping), tissue adhesive (you call it medical glue) or staples.
What’s the glue that’s being used?
In many circumstances, tissue adhesives not only can be used but should be used. Tissue adhesives have similar results as sutures in cosmetic results (i.e. appearance), breakdown rates, and infection risk. That said, some types of wounds, some situations and some locations prevent the use of tissue adhesives. Ask your physician if a tissue adhesive is a reasonable option.
Can I just use some form of glue at home?
No. It’s not the same, and if you try using some commercial glue, paste or needle and thread on your cuts at home, you’re asking for a ferocious infection in a few days.
Will I always need a shot for my numbing medicine?
No. Ask your physician if a topical medicine option is appropriate, especially in children or those otherwise wanting to avoid needles.
How long do stitches stay in?
Here are some guidelines based on the location of the laceration.
|Face||Three to five days|
|Scalp||Seven to 10 days|
|Arms||Seven to 10 days|
|Trunk||10 to 14 days|
|Legs||10 to 14 days|
|Hands or feet||10 to 14 days|
|Palms or soles||14 to 21 days|
How do I care for myself after the cut has been fixed?
Follow-up for repaired lacerations is pretty similar regardless of the method used to repair. Consider the following.
- Keep the wound clean and dry using a protective dressing for at least 24 hours after the repair, unless tissue adhesive was used, in which case no dressing should be applied.
- An antibiotic or white petrolatum ointment can be applied daily to wounds not repaired with tissue adhesives. That’s right, white petroleum ointments are just as effective as antibiotic preparations.
- If you’re received a tissue adhesive, you must avoid white petroleum or antibiotic ointments over the wound site, as these can dissolve the tissue adhesive, causing the wound to break open.
Even if you’re not asked, you should always ask if you need a tetanus vaccine after a laceration. The answer will always be yes if it’s been more than 10 years since your last immunization, and in selected cases it will be indicated if it’s been more than 5 years.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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