Stitches (Sutures, Wound Closures)
Medical Author: Benjamin Wedro, MD, FACEP, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
Why is wound closure important?
The ability to close a skin wound is an important skill learned by medical
care providers. Whether the skin injury was made by a scalpel in the operating
room or by a fall in the street, the decision as to how and when to repair the
damage needs to be individualized for each patient and situation.
The skin has many layers from the epidermis on the outside to the
subcutaneous tissue and the dermis in between. Each of these layers has other
sub-layers that help the skin perform its functions. The skin provides a barrier
to the outside world and the dangers of infection, environmental hazards and
chemicals, and temperature. It contains melanocytes that can darken or tan the
skin while protecting from ultraviolet radiation and it also plays an important role
in temperature regulation.
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| A picture of stitches or sutures |
Different options exist for repairing lacerated skin and providing a nice
cosmetic outcome. However, there are two important steps that need to occur
before the skin is closed.
- Exploration: Most wounds need to be examined and explored to their full
depth, looking for dirt and debris that may have entered and making certain that
the anatomic structures are intact and not injured. For example, in a hand or
finger laceration, the care provider will want to make certain that the tendons
beneath the skin have not been cut. This is done both by physical examination
looking for weakness or loss of motion and by looking into the wound,
identifying the tendon and seeing that it is normal.
- Cleaning: When the skin is broken, the outside world invades the body and
has the ability to cause infection. Before the skin is closed, the wound must be
washed out or irrigated thoroughly to prevent the occurrence of an infection.
Sometimes, a small amount of dirty tissue needs to be cut out, and this is
called debridement.
The purpose of wound care is not simply to yield a good-looking scar. All
wounds will eventually heal, although closing a wound will make the healing time
shorter. The purpose of going to a health-care provider is to get the wound
cleaned and make certain everything is in good working order beneath the damaged
skin.
When a laceration occurs, there are some reasonable first aid and home-care
steps to consider. Washing with tap water to clean the wound is always helpful.
Studies have shown that plain soap and water are as good as any special soap for
cleaning wounds. The wound should be lightly bandaged and elevated if possible.
The amount of blood supplied to different parts of the body varies. A wound
on the face, scalp, and hand may bleed profusely while one on the shin or back
may not. Bleeding will often stop with direct pressure at the bleeding site and
elevation of the injured part of the body.
Next: How does the health-care provider assess a wound? »
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