Stitching a Wound When Asking for Help Is Not an Option

With clean water or sterile solution, we drop the liquid on the wound for a few seconds. After we do that, we proceed to clean the wound with a sterile gauze or clean cloth. Cotton is not recommended as it leaves a lot of residue that can become contaminated over time. Although solutions such as povidone are not always necessary, this will depend on how dirty the wound is. In my daily practice, I do not use povidone for wounds because it slows down the scarring process. I always prefer alcohol or hydrogen peroxide. If the wound is larger than two inches and looks open, that injury will require stitches.

Step 1: Stop the Bleeding

In order to suture and evaluate the work being done, it is necessary to stop the bleeding from the wound. Once the injury is sutured, the bleeding will stop in 85% or more of the cases. The first measure we should take is to put direct pressure on the wound for at least two minutes or apply ice. Be careful with ice as it can burn the skin. If these measures do not stop the bleeding completely and the wound is in the arms or legs, it is necessary to place a tourniquet to be able to work without problem. The tourniquet is a device used to put external pressure on the blood vessels that are causing the bleeding until the cause is fixed. The Red Cross recommends placing it two inches above the injury. However, if it is placed higher, there will be no further damage to the patient. Although there are special materials for and even professional tourniquets, the truth is that you can improvise with almost anything that can form a loop around the limb where you want to place it. If you have a latex glove, this can serve as a tourniquet. You must place it over the bleeding injury. In the section on the cardiovascular system, we expand on the subject of bleeding. Here we only touch on the topic of tourniquets for moderate bleeding.

Step 2: Prepare What You Need for the Procedure

Ideally, you should have professional suture material: either nylon thread, which is what us doctors use to suture the skin, or surgical skin staplers that are very practical, fast, and easy to use. The surgical nylon thread comes with the needle attached. This needle can be straight or curved; the straight one is easier to handle and does not need any special surgical equipment. The stapler comes preloaded and sometimes contains a kit that includes the device to remove the staples once the wound is healed. You can also buy this remover separately if your stapler doesn’t include it. If you do not have any of these materials available, you can use sewing thread and a needle. Be sure to sterilize the needle by placing it over a flame for 30 seconds. Floss is also a strong material and could be an option, although it is a bit thick for what we want to do. You will also need a pair of scissors and sterile gauze or a clean cloth, enough to support the site to be sutured and to clean the wound after the procedure is done.

Step 3: Anesthetize the Wound

Make sure the wound is well cleaned, with no traces of dirt or other debris. It does not hurt to reclean the area with soap and water or to use alcohol to disinfect it. If you have anesthesia (1% or 2% lidocaine), you can inject 1cc into the edges of the wound without deepening it. Anesthetics like lidocaine are available as gels, creams, liquids, and sprays. You can use any of these presentations if the idea of injecting the fluid into the wound does not sound appealing to you. If this situation finds you unprepared, you can always proceed to numb the area with ice for one minute on the wound.

Step 4: Stitches Procedure

Whether you use a stapler or thread, the first thing you need to do is determine the direction of the wound so you can suture in that direction. To be well oriented, push the wound together with your fingers. The first stitch is placed in the middle of the injury. This way you ensure that it remains in a straight line and that it heals properly without lumps. If you use thread, you shouldn’t go too deep with the needle. Start the stitch about 0.2 inches outside the wound. Pass the needle through the two edges, secure it with a double knot, and cut the thread. The knots should not be too tight or too close together as this can cause necrosis and death of the skin. Remember that the wound caused some blood vessels to be sectioned, so this tissue does not have good vascularization. You should place the second suture halfway between the end of the cut and the closest stitch. Repeat until the wound is sealed. A four-inch wound requires between two to six stitches, but this can vary.

Step 5: Wound Cleaning and Aftercare

As soon as you finish, disinfect the wound with alcohol and cover it with sterile gauze or clean cloth. If you have any antibiotic cream, you can use that too. I do not use or recommend using povidone iodine (betadine) on wounds as it slows down healing and can cause a burning sensation. I prefer alcohol, and it is what I use in my daily practice. Never use cotton wool or pads to clean the wound because these give off fibers that remain between the threads and can cause contamination. The stitches must be cleaned daily with soap and water and should be left for seven to eight days. A week later, check that the wound looks like it is healing; sometimes it develops a small scab. One sign that the wound is healing is that it starts to itch. This should not worry you as it is part of the physiological process of skin healing. The stitches should be removed with attention so that no trace remains inside the skin. However, if there is any residue left, the skin itself will take care of expelling it eventually. Surgical staplers have their own special device to remove the staples from the skin. It’s easy to use and fast. The total skin recovery process takes up to one year, so if you feel a little bump or see that the scar is a darker color than the rest of the skin, you just have to be patient. Eventually that skin will look almost the same as before.