Wednesday, March 23, 2011

Stitch Me Up!!

Often times in fiction, regardless of genre, our characters need to suffer a little mayhem to increase the conflict, like a physical injury. Today, I thought I'd give some routine guidelines for care of a laceration that would require stitches as background information for these scenes.

Cuts are preferably closed within 6-8 hours after injury. Long outside shot is 24 hours and only if the physician feels the wound is not highly contaminated.

First, the wound is generally cleaned with copious amounts of sterile saline. This is to wash out any debris/germs that are in the wound to prevent infection. Prior to this, the wound is generally "numbed" up. In kids, we use a topical gel called LET which is a combination of three substances (lidocaine, tetracaine, and epinephrine). This substance can be used on most cuts except the ends of certain areas (fingers, toes, nose.)Yes, I know that rhymes. It helps us remember! LET sits in place for approximately 30 minutes and then we irrigate the wound.

If the laceration is in an area where LET cannot be used, then the physician may use a digital block, which is an injection of anesthetic near a nerve site, to numb up a whole area, like a finger/toe.

Adults are given local injections of an anesthetic, typically Lidocaine, then the wound is irrigated.

If the cut is on the scalp, staples are used for closure. If the cut is in an area where the laceration will stay closed with movement (like under the chin), then the physician may choose to use Derma-Bond, which is a medical grade glue. However, if the cut is under "tension" it will need sutures. If the cut is near a joint, then the area will likely be splinted to ensure the stitches don't rip.

Here are guidelines for how long stitches need to stay in place.
Face: 3-4 days
Neck: 5 days
Scalp: 6 days
Chest/Abdomen/Arms/Back of Hand: 7 days
Leg/Tops of Feet/Back: 10 days
Palms of Hands/Soles of Feet: 14 days

The sutured area should stay undisturbed for 24 hours. No soaking in the bathtub or swimming until the stitches are removed. After the first 24 hours, the wound can be gently washed twice a day and covered with an antibiotic ointment to help prevent infection (unless glue or dissolveable sutures are placed-- then no ointment and most often no washing).

A tetanus shot will be given if the patient hasn't had one in the last five years.

Question for you: Why do stitches further away from the heart need to stay in longer?


  1. Great post, and a nice refresher for those of us who haven't picked up a needle-holder and forceps in a while.
    And, of course, I know the answer to your question, but I'll stay mum and let your readers take a guess at it.
    Keep up the good work.

  2. Thanks Richard. You must be getting excited for the release of your latest novel!

  3. To answer the blog question, why do stitches further away from the heart require the stitches to stay in longer? The answer is that these areas are further away from the heart and not as highly vascular (rich with blood flow) as areas close to the heart so healing is prolonged and stitches need to stay in longer.