Question About Stitches?

Question

I got this secondhand, but my younger brother apparently fell at work yesterday and got a bad cut on his arm. He waited until this morning to tell anyone about it, and he is going to urgent care to get it looked at and probably get a tetanus shot. My mom said they might not give him stitches, though, because most medical professionals won't suture after a certain amount of time has gone by. Why is that? She wasn't able to tell me.

Answer 1

There is indeed a time window. After a few hours, even with meticulous wound care, the risk of infection goes up substantially. Primary closure has to be done within a few hours. Now the choices will be allowing it to heal secondarily, or waiting a few days for a delayed closure, which is a little more complicated but a valid alternative to minimize scarring.

A lot of the history of wound care, and when it's OK to close them, is military. The same lessons were learned in the two world wars and to a degree forgotten after each. The Vietnam War re-taught the same lessons, and this time they stuck among the medical profession.

Answer 2

Generally, you can't get stitches after 6 hours.  By that point all bleeding has stopped (one way or another) and the wound has already begun to heal.  He still should seek medical attention to get a tetanus shot and make sure the wound is clean and bandaged.  Also, since this injury happened at work, he should have sought medical attention immediately.  His employer could get in trouble if care was delayed.

Answer 3

Just to add to the previous answer, the reason that we don't stitch after a certain amount of time is mostly that after about six hours, the risk of sealing a contaminant into the wound is greater than any advantage to be had from aligning the edges of the wound, which is really mostly done to minimize scarring (all wounds will heal eventually, but "primary closure" of the wound with stitches or staples or tape will give the best cosmetic result).

Some wounds, like animal bites and ulcerations, are never closed but are always allowed to heal on their own.  The "golden hour" for stitches, if you're going to do them, is usually six to eight hours, but in a very clean wound or one that is in a very visible location, like on the face, they may go up to 36 hours as long as there is no suspicion for infection.