How late is too late for stitches?

I got stabbed in the back with a broken beer bottle once . . it took at least a week before it actually stopped bleeding. Profusly. After awhile it clotted but nerve damage is always a factor .. I suppose . . I have a brutal looking lump/scar there now

Canotila said:

If someone has a really deep laceration that isn't treated in any way other than just letting it dry, how long can it go untreated before stitches aren't an option anymore? Is one day long enough? Two? Longer?

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It depends. I wouldn't stitch anything that was open for more than a day. If it was really bad and desperately needed to be closed then I would have to cut into it again, taking a little more off the edges and opening the cut again so I could seal it properly.

The thing is, the wound will start to heal itself pretty quickly, and once it starts to scab then it's really too late for stitches, you need to get them in while the wound is fresh.

This would be affected by the temperature and if there was a lot of moisture or very little moisture. Wounds clot quite differently on a 90 degree dry summer day than if the wounded person is drenched with rain or half-frozen.

sunandshadow said:

This would be affected by the temperature and if there was a lot of moisture or very little moisture. Wounds clot quite differently on a 90 degree dry summer day than if the wounded person is drenched with rain or half-frozen.

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Generally though if the wound has started to scab then it's too late for stitches.

How deep is the cut? If it is too deep, so that it is bleeding profusely, there may be a risk of shock from blood loss and if it is allowed to bleed too long without being stopped (either by a bandage or stitching) there is a risk of losing enough blood to enter irreversible shock (around 3 pints) where a transfusion is the only way to recover from it (and even then it has to be a quick one).

The other big risk here is infection. An open wound left like that for a long time is a massive risk for infection unless it is cleaned out straight away and infection is the biggest killer in traume medicine after shock. The blood flow initially will probably help to clean it out and push any infectious agents away from the wound but once it starts to clot the infection risk increases unless it is cleaned and kept clean.

Even if infection does not kill you (septicaemia is a major risk with open wounds) there is still the risk that wound healing will be impaired by the infection and will therefore take longer and be less effective.

Stitching serves two purposes. One is to keep the wound closed so that it heals easily and neatly - minimising a scar by pushing the two edges of the wound closer together. Without this, the tension of the skin will keep the wound open and the cells have to grow into the gap to bridge it. This takes longer, risks more infection and leaves a greater area of scar tissue. The other role is to prevent blood loss. This latter role is more important in deep wounds that have severed major vessels and then it would normally be a surgeon who would find the bleeds and stop them - stitching up each damaged vessel to repair it.

I knew my Masters thesis in wound healing would come in useful one day

Thanks for this thread; it'll be a great help for chapter one of my NaNo novel!

(Yes I'm doing it this year. Must be mad...)

I frequently see wounds more than a day or two old in dogs and cats. They can still be stitched, but you have to be careful. Infection is a problem. Sometimes drains are used to help. The sides of the wounds will frequently need to be freshened - in other words, you scrape off some of the new scar tissue and make it bleed a bit. Then you close with sutures. You often don't want to close it fully, but healing can be helped if you close at least partly. Antibiotics are, of course, part of the treatment.

lbender said:

Then you close with sutures. You often don't want to close it fully, but healing can be helped if you close at least partly. .

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This also.

I've seen too many cases, mostly by inexperienced vets and nurses, where the wound is completely closed, which allows for no drainage. This means that everything just sort of festers, and this is where infection is a major issue.

I may be wrong but I do remember the process of removing some of the tissue on either side of the wound to be called 'debriding' in a surgical text book I read.

It also aids healing because the fresh damage releases fresh wound healing factors into the wound area (as well as other cytokines which attract more immune cells which are also useful for preventing infection). Wound healing factors work by stimulating the growth of cells as well as making sure that the right bits join to the right bits - such as, for example, making sure that the two ends of a severed nerve cell join up or the two ends of a severed capilliary.

Grossest thread ever. But thanks. I learned something new.

I don't know how modern your plot is, but our ER told me after six hours they don't do stitches. I had come in for stitches the next day, and they used some kind of tape instead. I'm assuming that advice was for your general cuts, though (which mine was).

Sat Nam! (literally "Truth Name"--a Sikh greeting)

Sometimes puncture wounds aren't stitched at all. I once stabbed myself while trying to open a coconut with a sharp short kitchen knife. The doctor put a "butterfly" tape on the wound, but said if he stitched it, it wouldn't heal right. Then he gave me a tetanus shot. End of story, except that I've still got the scar.

Blessings,

Siri Kirpal

Sometimes we used superglue - especially if the wound was in an awkward place, or in a place where you wanted minimal scarring. I cut my finger down to the bone once, right at the joint and they used glue rather than stitiches to reduce the bulk and the scar tissue.

Canotila said:

If someone has a really deep laceration that isn't treated in any way other than just letting it dry, how long can it go untreated before stitches aren't an option anymore? Is one day long enough? Two? Longer?

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I had a wound such as this one time as a result of a bicycle accident. It was fairly deep puncture wound. At first we were just going to let it go (I was always getting banged up anyway), but then decided it might be better to see a doctor since it wouldn't stop bleeding.

At the doctor's office he told us a wound normally needs to be stitched up in the first 24 hours. He then send us to see an old doctor who worked in the hospital emergency room. The doctor treated the wound and then stitched it up (it has been something like two days or more). For several years I had a "smilie face" from the scar on the inside of my left foot right below the ankle. So, while 24 hours might be the standard answer, and what is preferred, it isn't set in concrete.

When I was 12, I had a rather nasty deep laceration the night before we left on a family vacation. The ER doctor said it didn't need to be stitched, bandaged me up and sent me on the trip. I got home a week later with massive swelling, pain and fever. The bleeding never did stop that week, it just subsided to a light ooze (TMI, I know). The next doctor told me it should have been stitched immediately. He opened it up, drained out the fluid, and stitched it up. I recovered fine at home with antibiotics, but my parents were pissed at the original ER doctor. I had a bit of a scar for awhile, but it gradually went away.

Canotila said:

If someone has a really deep laceration that isn't treated in any way other than just letting it dry, how long can it go untreated before stitches aren't an option anymore? Is one day long enough? Two? Longer?

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We encourage our deep laceration clients (anything through the fat layer into muscle) to get RIGHT to the local doc, because the inner layers need to be stitched correctly or they can misalign and heal wrong, leading to impaired function. And fixing a badly healed wound means making a bigger opening, cutting out the badly healed stuff and connecting things right.

Healing starts as soon as clotting is well started - a couple of hours.

Example: A guy with a 2-inch knee slash took 80+ stitches on the inside to get all the stuff re-connected, and he only had 5 holding the skin closed.