Instructions:

Your 5-year-old falls at the park again after attempting something insane, like jumping from the top of one picnic table to the other. He runs to you sobbing with his hand holding the side of his head, and all you can think is, “He knows better!” You interrupt your first adult conversation of the day [...]]]>

Your 5-year-old falls at the park again after attempting something insane, like jumping from the top of one picnic table to the other. He runs to you sobbing with his hand holding the side of his head, and all you can think is, “He knows better!” You interrupt your first adult conversation of the day to give him a hug only to see blood gushing out from between his fingers. After suppressing the urge to laugh hysterically, you switch to emergency mode, apply pressure, snag a piece of ice from another mom’s cooler, all the while making soothing sounds and saying, “You’re OK,” over and over.

Many parents have been there before, except for those rare creatures whose kids always make ‘good choices.’ For the rest of us, the next big question, after making sure he’ll live, is, “Do I really have to take him and my four other kids to the hospital and pay a $100 co-pay?”

This was me last Friday. Plus, my 3-month-old baby woke up because of all the shrieking and wanted to nurse. And my three other kids, 8 and under, were playing at the park and didn’t want to leave, “RIGHT NOW!”, and get in the car.

TIP : Find the closest urgent care clinics covered by your insurance before the next emergency. The co-pay is usually half what the ER costs. There’s no time to do this when the blood is gushing – I know!  Make sure to give them a call and ask specifics: do they place stitches, have an x-ray machine, cast broken bones, and have a nebulizer or ‘breathing treatment’ machine? You don’t want to arrive, only to find out it’s a geriatric urgent care.

So, I’ll share my hard-won knowledge with this quick and practical ‘How-to’ guide on wounds and stitches:

1. How many layers deep is the cut?

If the cut goes through multiple layers of skin, it usually needs stitches to keep the wound edges in the right place while it is healing. Not to be gross, but if you can see something besides skin, like bone or yellow bits of fat, deep in the cut, then you should get stitches. In general, a cut more than a ¼ in. deep should get stitches.

2. How long is the cut and does it gape open?

The longer the cut, the more the wound edges can move around and heal ‘crooked’ or with bunched up areas of skin. Also, if it gapes open it will likely heal that way with a wider area of scar tissue. A good rule of thumb is to get stitches if it is over ¾ of an inch long.

3. Are the edges clean or ragged?

A small cut by a kitchen knife is a great example of a cut that doesn’t need stitches. The straight edges of the wound will heal with almost no scar. An impact wound that has pulled the skin apart leaving ragged edges will have a hard time healing well. The ragged edges need to be trimmed smooth before stitching so they don’t bunch up while healing or die off providing a nice spot for an infection to take hold.

4. Are there possible serious complications?

This may seem like a no-brainer, but if the wound is near anything important, you should get medical treatment. This would be anywhere with important nerves, like cuts to the face, hands and feet. Also cuts deep and close to joints should be stitched for two reasons: One, they are a pain to keep from opening up every time you bend the joint, and two, an infection that gets into a joint can be very serious. Plus, make sure you have an updated tetanus shot if there are any suspicious objects involved in causing the wound.

5. Where is the wound? (ie. Do you want a scar or not?)

Ok, if you really don’t care what it’s going to look like afterwards, or you enjoy using the occasional scar as a conversation starter, then you really don’t need to get stitches for minor injuries. Your body will just fill in the area with scar tissue. Your main goal, in this case, is to clean the wound and keep it from getting infected.

If you decide to stay home (and save the copay)

1. Start by cleaning the wound out well. Irrigate gently with lots of water and make sure to get any particles, rocks, slivers, etc., out of the wound.
2. Put on an initial antibiotic treatment – ointment, first aid wash, etc.
3. Apply any herbal wound remedies you like.
4. Use a bandage to hold the wound closed in the way you want it to heal.

If you’re using a bandaid:

• Get a good quality one that will stay on well – the fabric ones seem to work best on my kids.
• Attach the bandaid to one side of the wound, pull the skin and wound closed, as straight as possible, and stick down on the other side.
• Start at one edge of the wound and work your way to the other (or the middle and work your way to the edges). Don’t be afraid to use plenty of bandaids. If you leave any of the wound gaping, it will heal that way. Try to keep the bandages protected and dry so they keep the wound edges together for at least the first 3 days or so. The less you disturb the wound, the less it will scar, and the more likely it will heal the way you bandaged it.

If you’re using ‘closure tape’ or ’steri-strips’, which you can order from medical supply stores:
(For those who have lots of crazy, ‘no-fear’ little boys, and want to plan ahead)

• Paint a bit of Benzoin Tincture on either side of the wound without getting it in the wound – think ‘glue stick’. You can buy this at the ‘old school’ pharmacies in most areas – call around. It really helps the closure tape stay stuck for days instead of hours, but you can do without it in a pinch.
• Ditto above: Apply the tape to one side and pull the wound closed as straight as possible and stick it to the other side. Continue until the entire wound is pulled together as straight as possible.

Good luck and if you’re curious to see how our picnic table adventure ended, see my next post on how to remove stitches.