stitches

Stitches (sutures) are often required to repair a bad cut (laceration). All cuts will heal by themselves. The function of the stitches is to ensure that the cut heals much more quickly, with less chance of infection, and with much less scarring than if left alone.

Obviously, not every cut requires stitches. If the cut gapes open, especially if you can seen yellow fatty tissue in the wound, your child probably is going to need some stitches.

Sometimes, if the wound is short and shallow, you can use butterfly bandages to close it snuggly. If the edges of the wound stay together tightly and you think the butterfly bandages will stay on, that's probably enough. I'm leery of butterflies on the face, not because they don't work, but often leave a wider scar which is unacceptable.

Believe it or not, stitches really shouldn't be painful. Rough and hurried handling of small children by big-people doctors is the major contributor to bad experiences getting stitches. I can usually sew up a cooperative child without tears by using a very small needle for the lidocaine anesthesia, and by injecting slowly into the cut edge of the tissue. It takes a few minutes longer, but it's worth it. (I hope your doctor doesn't get mad at me.)

When in doubt about whether your child needs stitches, call your doctor. Even if there is no doubt, you should call. He or she will appreciate the warning before you show up in the emergency room or the office, and often can expedite your child's treatment by meeting you there. In many ER's, the doctor isn't called until the child is ready to be treated - that can mean a long wait on an uncomfortable chair. Ask about your emergency room's policy in advance if you can.

The new skin adhesive (Dermabond®) can be used to repair selected lacerations. While it seems like an ideal solution to the fear and pain of laceration repair, in practical use the skin adhesive is somewhat tricky. The skin to be repaired with it must not be an area subject to pulling or traction (no chins or knees). The manufacturer claims that the cosmetic results are as good or better than sutures; that has not been an experience shared by me or some of my primary care colleagues. If your child's doctor thinks it is OK to use, that is fine, but do not push her to use it just to avoid a needle. Pain is forgotten; scars are forever.

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