When Does a Cut Need Stitches?

It’s tricky to tell whether a cut or scrape needs a doctor’s attention.

Everyone gets skinned knees, small cuts, puncture wounds or animal scratches occasionally. And many minor lacerations heal without medical intervention. But some injuries require stitches or other types of treatment to ensure proper healing.

Whether it’s a child or adult who has the cut, it may warrant a visit to an emergency department. But how do you tell?

“It can sometimes be difficult to tell if an injury will require stitches or not,” says pediatric emergency medicine physician Purva Grover, MD. “It’s really a judgment call and a challenge for a parent to ascertain the difference.”

And it can be especially scary and worrisome for parents and caregivers to deal with cuts and puncture wounds on their kids. If you’re unsure if your child needs a trip to the ER and possibly needs stitches, it’s better to seek immediate medical attention.

So, when does a cut need stitches? Dr. Grover and emergency physician Baruch Fertel, MD, offer some guidance on when to visit an ER for a cut and what to expect if you get stitches.

Does a cut require an emergency department visit?

“Certain lacerations and wounds almost always require a visit to the ER or urgent care center,” says Dr. Fertel.

Both doctors advise heading to an ER for evaluation if the wound is:

• Deep enough to expose the dermis or yellow subcutaneous fatty tissue.
• Gaping open so that you can’t easily use gentle pressure to press the edges together.
• Located on or across a joint. (You may also have damaged nerves, tendons or ligaments.)
• The result of an animal or human bite. (You may need a tetanus booster shot or oral antibiotics, as well as stitches.)
• A result of a foreign object impaling the area.
• Made by a high-pressure impact from a projectile like a bullet.
• Contaminated or resulting from a very dirty or rusty object.
• Bleeding profusely (and flow doesn’t appear to slow).
• On a cosmetically significant area like the face.
• On or near the genitalia.

Basic first aid for cuts

If you decide to go to the ER or urgent care center, here’s what you need to know about how to care for the cut until you receive medical attention:

1. Leave foreign objects alone

Don’t remove any foreign object — like a piece of wood or metal — stuck in the wound, says Dr. Fertel.

“You don’t know what the foreign object has struck underneath,” he says. “More than once, I’ve seen cases where the object has struck an artery and is blocking the bleeding. The moment you pull it out, there’s no longer anything there to block the arterial blood flow and this can cause devastating consequences.”

2. Bites and dirty wounds need special treatment

If an animal or human has bitten you, a family member or friend and the laceration is more than a very superficial abrasion — or a contaminated or rusty object caused the injury — seek medical attention immediately.

For adults, if you haven’t had a tetanus booster shot within the past 10 years, you’ll need one now.

Most children have had tetanus vaccinations, but these types of injuries require medical evaluation anyway. The attending physician may prescribe oral antibiotics as well.

3. Clean the wound if you can

If possible, gently clean the injured area before visiting the emergency department by thoroughly irrigating it.

Dr. Fertel suggests using tap water and a dilute liquid antibacterial soap to do this. This is a good way to clean off almost any wound.

He says hydrogen peroxide doesn’t work well for wound cleaning. It damages the tissue.

“One of the best things parents can do before bringing their injured child to the ER is clean the wound, but only if they have the time and expertise to do so,” he adds.

4. In case of stitches, avoid food and drink

Dr. Grover advises parents to avoid giving an injured child anything to eat or drink before going to the ER.

“If they have eaten something recently and start getting very upset, they might vomit, further escalating the stressful situation,” she explains. “Also, in the rare occasion they might need any sedative or anxiety medications, it’s advisable to avoid a heavy meal.”

5. Apply direct pressure and elevate

On the way to the hospital or clinic, apply direct pressure and elevate the injured area.

This will usually help slow or stop most bleeding. Most of all, remain calm and drive safely. You wouldn’t want to complicate the situation by getting stopped for speeding or, even worse, an accident.

How to treat a minor cut at home

If your cut or scrape is very minor — not deep or contaminated — treat it at home by irrigating it as suggested above, and then dress it with a topical antibiotic and a bandage.

Both doctors recommend keeping the area clean and reapplying antibiotic ointment and a bandage several times a day when caring for a minor cut at home.

Keep a close eye on your wound to monitor healing. If you become concerned, visit a healthcare provider right away.

How to care for stitches

If your provider determines that you need stitches, a suture or string will be used to bring the cut or wound together.

As a sharp needle is used, you may be given a numbing medication or local anesthetic to help with pain.

It’s important that you properly care for the stitches once you return home. Your care team will provide more information, but basic care includes:

• Keep the area clean and dry for about 48 hours after getting stitches.
• After those initial 48 hours, you can gently clean the area with cool water and soap.
• Use a clean paper towel to dry the area. Don’t rub the area or use a cloth towel.
• Replace any bandages daily and apply antibiotic treatment, if needed.

“Depending on the location and kind of suture material used, your physician will advise you when to get them removed,” says Dr. Grover.