Urgent Care: Stitches, Steri-strips, and Dermabond

Lacerations are considered a minor emergency since they need to be fixed urgently. Believe it or not, the skin heals very quickly.   Although the entire wound may not be closed, a wound becomes more difficult to stitch (suture) back together as time passes. By 12 hours, the wound may not heal correctly if stitched together. It is important to get seen quickly when you have a laceration. You do not have to go to the Emergency Department, we can stitch you up right in our office. We now accept Walk-In and Urgent Care visits throughout our usual business hours.

Why do wounds heal so quickly? Why is it so difficult to suture the skin back together after 12 hours?

The healing process involves a phase called “epithelialization.” The outer layer of skin is called epithelium. It has distinctive cells that are not found in the deeper tissues. When the deeper tissues are exposed by a deep cut (laceration), the body covers the deep tissue with epithelial cells in order to protect it. As you can see from the picture, the pink tissue in the laceration is epithelial cells that are trying to cover the gap. After epithelium grows inside the wound, stitches will not improve the outcome of the wound. It is like trying to get rid of a wrinkle by stitching the two flaps of skin together. Trust me – it doesn’t look good. There’s a reason why doctors don’t do it. After the epithelium grows inside the wound, it then becomes less painful, and the burning sensation subsides. Next, the body begins dumping scar tissue into the gap as if filling up a hole dug in the back yard. Eventually, the scar tissue pushes the epithelium to the surface, and you have a permanent scar.

Moral of the story: When you have a laceration, please utilize our Urgent Care hours as soon as it happens. Do not wait until the next day.

stitches

What are my options for fixing lacerations or deep cuts?

stitchesStitches or Sutures – These are sterile strings attached to curved needles that healthcare providers use to pull skin close together. When the skin is pulled together appropriately, the body is able to fix the wound much quicker, and the scar looks cosmetically pleasing. If the provider is good at suturing, your wound can nearly disappear after it is fully healed. It is important to put buried stitches that absorb over time in areas of high tension – have you ever heard of “white knuckling?” Your knuckles turn white when you make a tight fist because the skin is stretched so tight that it limits the blood circulation. This is an example of high tension skin, and it usually needs deep stitches.

IMG_1111This is a patient that cut her hand on glass in the sink.  It was a deep, high-tension wound that had fat tissue exposed.

After a few buried deep stitches across the wound, the wound appears completely closed. Using deep stitches minimizes skin tension which helps with the cosmetic appearance of the final wound. It is tedious and takes more time, but a good provider will use them when needed. You cannot see the stitches in the picture because they are buried beneath the skin, and the body will absorb them over time.

I still used stitches on the outside to help with the high skin tension and minimize scarring.

railroad_track_skin-e1369098411623If too few stitches are used or if the stitches are left in for too long, the stitches themselves can cause scarring called “Railroad Tracks” as can be seen by this picture (not my patient). The laceration itself has a scar, and then the stitches left perpendicular scars from too much tension.

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Butteryfly or Steri-Strips
are also frequently used for small lacerations that do not require stitches. These are usually lacerations that are smaller, and they are in an area of low skin tension. Steri-strips are designed to pull the skin together just like stitches. As long as the skin edges are pulled together and steadily held, the wound will heal nicely. Steri-strips are an excellent way of repairing simple cuts.

dermabond-microdiscDermabond (similar to Superglue) is a medical glue that can be used to “glue” skin edges together. The skin is gently squeezed together in an attempt to get the edges as close as possible. Then, Dermabond is applied to the skin overlying the laceration. The glue is intended to hold the outside skin together, and it is not meant to hold the deeper layers together as it interferes with the healing process. In other words, you cannot just dump Dermabond into a deep cut and pull it together like you would do with household items.

Dermabond is great for kids who would not otherwise sit still for stitches to be placed. A child is pictured with a fresh laceration. It was then fixed with Dermabond (pictured).

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3 months later, the scar is nearly invisible. Kids heal much better than adults, so the same cosmetics do not apply to adults.

#DrOubre

#stitches #urgentcare