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Does Youngest Require Stitches?

Even after dealing with the illnesses and injuries of three kids over fifteen years, I'm never certain if a cut of any kind requires only a simple bandaid/gauze pad or actual stitches.  And Youngest today cemented his family title of Stitch King with an injury that initially scared the hell out of me:  an inch long laceration under the left eye.  And it begged the question of whether or not he needed stitches or just some antibiotic cream and a gauze pad over the eye.

Why Stitches?

Stitches, also called sutures, are simply used to assure that the edges of open wounds are held together long enough to permit the skin to heal itself.  The principle is the same as stitching fabric together, except that in time, skin can heal over an open wound.  With the edges held together closely enough, the wound is also provided further protection again an infection and scarring is minimized.

In this instance, Youngest was in the side yard tossing a piece of PVC pipe in the air like a baton when an end landed on his face.  Because the pipe had been cut, the striking edge of the pipe was rough and caused a laceration of about one inch below the left eye.  Most specifically, the crease where the cheek meets the pouch of skin beneath the eye.  He came around to where I was cutting bushes with his hand covering the eye and my stomach turned when I saw the wound.

Stitch or Not?

Physicians use several criteria for deciding whether to use stitches or not.

• The amount of blood emanating from the wound isn't necessarily an indicator of stitches.  In this instance, Youngest had very little blood loss, especially since many wounds around the face and head can bleed heavily.
• Are the skin edges of the wound so far apart that they can't be easily pinched together?  Youngest's wound looked like a typical laceration in that there was an obvious cut but the wound wasn't gaping.
• Can you see the deeper layers of flesh - called subcutaneous - beneath the top layer of the skin itself?  When I dabbed the wound with a clean, wet washcloth, I saw that the top edges of skin were peeled slightly back so that I could see deeper layers of tissue despite the narrowness of the wound.
• Is the location of the wound such that scarring might be an issue?  A physician might be more likely to suture a wound in the face or other visible area to minimize scarring.  Youngest can't avoid the coming shiner and sutures, but we can minimize the scarring over the long-term.
• Is the wound located where there's a lot of body movement?   A similar gash on the knee would certainly require stitches simply because the constant stress of skin movement at the injury site would delay healing because of persistent stress on the wound edges. 

In Youngest's case, the visibility of the subcutaneous tissue and our desire to minimize facial scarring led the ED physician to use six stitches to close the wound. 

Sources:

http://firstaid.about.com/od/softtissueinjuries/a/06_stitches.htm

www.emedicinehealth.com/removing_stitches/article_em.htm

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