Calling all medical professionals! How many stitches for the face?

From personal experience: when I was 17 I was in a car accident and (among other injuries) had a facial laceration. My cut was maybe 1/4 inch below my eye, from the corner of the eye to just shy of the pupil, and I believe I had 4 stitches.

One tidbit with stitches - more stitches generally means less of a scar. So for a facial laceration, they'd probably put the stitches very close together (and have less of a scar). On the other hand, when I had stitches in my knee many many years ago, I had 5 stitches for a two-inch-long cut, and still have a pretty big scar from it.

In my case- I received stitches from a plastic surgeon and maxo-facial surgeon. I had also broken my nose, so between that and the laceration they got the best guys in the hospital to fix me up.

I do remember, when I had the stitches in my knee, the nurses did a lot of the "prep" work, but it was the doctor who administered the local anesthetic and the doctor who did the shots. Probably a run of the mill ER doctor, I don't remember. I could definitely buy an average ER resident starting the stitches, and then the patient insisting on a plastic surgeon.

How long the stitches stayed in... it was about a week, although they had to stay moist. I was admitted to the hospital for some other (more serious) injuries, so the nurses would take care of the stitches.

I don't think that particular gouge would cause swelling around the mouth. Are there other bruises? How did she receive this injury?

I think it also depends on what causes the cut. A thin blade would make a cleaner cut than a broken bottle.

In hospital I work at, nurses will do the sutures for something small (say two to five stitches) and the ER doc will double check it. For something big like you're describing, the ER doc would do it, unless the patient insisted (and had the money to afford) that a plastic surgeon be called in. Most sutures stay in for a week, week and a half before the person has to come back to the ER and have them removed (which a nurse will do). The cut does not have to be all that deep for large amounts of blood (though bleeding for 45 minutes is unlikely, as is "gushing"), the face is a prime area for superficial wounds, ones that look far worse than they really are.

As for the number of stitches, I couldn't say for sure, but it'll be somewhere in the double digits for a laceration that long.

Physician here

First- no way would a nurse stitch that up. It would be a physician, or perhaps a very, very well-trained PA. Is this story taking place in the USA? If so, chances are a plastic surgeon would be called in to do such a repair, since it's on the face and going up towards the eye, especially.

For facial lacerations where scarring is a concern, you would use very thin suture, and lots of stitches. I would guess we're talking about a 4 inch laceration here, so I'd guess a minimum of 20 stitches, perhaps more. If it was a very deep laceration, it would also likely be a layered repair, meaning that there is a layer of subcutaneous stitches that would dissolve, followed by a layer of superficial stitches.

Six stitches to close a laceration like you are describing would be medical malpractice.

Facial stitches are usually in a maximum of 5 days. Longer than that, and there is more scarring. Face skin heals fast.

typical ranges:
Face: 3-5 days
Scalp: 7-10 days
Trunk: 7-10 days
Arms and legs: 10-14 days
Joints: 14 days

from eMedicine Health

suestrong315 said:

lol, that's why I have you

She gets the stitches during a fight. A girl hits her in the face and a ring she's wearing has a jagged edge and tears her face open.
I'm not looking to spend 7 paragraphs on this moment. Basically the Dr comes in, checks her out, says how many stitches and does it, so if he needs to make mention "I'll call the plastic surgeon to come handle this" or w/e I just need to know that part.

Thank you all for your very helpful feedback

And Melin, I hope you made a full recovery. I've never been in a car accident or hospitalized for an injury...hell, I've never broken a bone, so I can only guess how painful what you described would be

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Thanks Sue, I did recover and now I have lots of great stories to tell from it. BTW - I do have a scar, but it is very very faint. I can see it because I know exactly where to look, but other people don't notice it unless I point it out. (Of course it's also been more than a decade, so it is greatly healed.)

One thought on the plastic surgeon, it might depend on the type of hospital. I was taken to a huge urban teaching hospital that has practically every kind of specialist on-call. If it was a really tiny rural hospital, they may not even have a plastic surgeon. Regardless I think you can play with that... an experienced ER doc could probably do it, OR a plastic surgeon, whatever works best for your plot.

Another thought, and I'm not a doctor so take this with a grain of salt, but I don't think doctors usually know *for sure* how many stitches a cut will need until they are done. They know that for a cut on the face, they need to do stitches that are x distance (one millimeter? two millimeters?) apart, but won't know until they are done exactly how many stitches that could be. HOWEVER, I would bet that an experienced doctor could look at it and make a pretty accurate guess as to the number of stitches. So I think they could come in and say, "I think that will be about 20-25 stitches", not "I know this will be exactly 23 stitches".

suestrong315 said:

well, six is definitely too little lol

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Obviously, lol. But if you want her to have a scar, you could edge toward slightly less on the stitches. Say, 15 or 16 (given a four inch wound, that would be ~4 stitches per inch) instead of 20 or 25 (~5 or 6 per inch).

Would the doctor even say how many stitches up front? I cut my chin once (very small) and needed five stitches. It's been awhile, but my memory of that was going in to the ER, and the nurse looked at it and saw that it needed stitches, told me as much, and then I was taken into a room. The doctor came in, gave me a shot to numb the area, and did the stitches. Once he was finished I asked how many stitches and he told me, but I don't recall him telling me how much.

What I do recall is him coming in and making small talk about it. Things like, "Oh no, what happened to you there?" I told him I'd fallen on ice and we actually joked about it. I'd been doing a fundraiser and I asked him if he wanted to donate, which made everyone laugh. I think he was just trying to keep me calm so I didn't worry too much about it by lightening the mood.

I'm not saying that's how you should write your scene, but the idea of the doctor coming in and saying, "Here's how many stitches you need," strikes me as a bit stiff. A better question might be what kind of personality does the doctor have, and how does he deal with the situation?

I know I'm making assumptions here based on the description, so please feel free to ignore me if I've just misinterpreted the scene.

It is quite hard to tell up front how many stitches you will need, even for a surgical incision. You don't know for sure how much tension the skin will bring in different areas, and more tension means more stitches to distribute the tug on each stitch that can distort the line of healing.

A common technique is to start suturing with any subcutaneous stitches (see NH Doggy's post above) and stabilize the area, if the cut is deep enough to require it. Then at the superficial level, use a stitch in the best-guess middle point. Move outward into the two divided areas on either side and put a stitch in the middle of each. Continue to subdivide until you are finished or it is clear that the area is fully stabilized with the edges approximated easily just as you want them.

If you start at only one end of the laceration, you may find a, hmm, hump building up on one side where the pull of the skin is different from the other side. Kind of like accidentally skipping a button on a coat, but with the last button of the coat already attached. Nonlinear lacerations are particularly prone to this match-up problem.

Plastic surgeons do an incredible number of tiny stitches with very thin suture material. Thin material means smaller stitch holes for the scar, but it doesn't hold tension as well, so you need a lot of them to distibute the force on each into a much smaller amount.

Plastic surgeons also tend to recommend soaking and loosening scabs that form, as the propagation of a scab stretches the approximated edges apart. They like to keep the sutured laceration moist and scab-free. Other physicians don't seem to harp on this point as much.

At a different time in my life, I did a fair share of sewing people up. I've sewn up a small lac on my own leg, though that's another story.

Times change, and I don't stitch much anymore. But it was a great technical challenge.

Make sure they rinse out the wound much longer than you think they need to. That's the most important part. If you stitch together skin with foreign debris left inside, it won't matter how prettily you do it.

Added: And kaitie's point about distracting small talk is a good one. It's also a measure of the experience of the person doing the suturing and how at ease he or she is with the situation.

Pyekett said:

If you start at only one end of the laceration, you may find a, hmm, hump building up on one side where the pull of the skin is different from the other side. Kind of like accidentally skipping a button on a coat, but with the last button of the coat already attached. Nonlinear lacerations are particularly prone to this match-up problem.

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Hm, I never thought about this but it makes perfect sense! Thanks, Pyekett- though my current WIP doesn't have anyone getting stitches, I am sure this information will be useful in the future!

(Both times I had stitches, I wasn't exactly paying attention to what the doctor was doing... once I was 10 and scared out of my wits to be in an emergency room, and the second time was after my car accident and I was unconscious.)

Somewhat related: my aunt once said she had a coworker who got a cut in the middle of a tattoo on his arm. The doctor didn't really care about the tattoo and didn't try to match it up evenly, so it looked VERY funny after it healed!

I smashed my face and split it open when I younger. I have a scar that comes down between my eyes and under the right eye to almost the outside corner of the eye.

I had almost 40 stitches - done by a doctor - and was lucky to keep my eye. The wound was maybe 5 1/2 inches going by the scar.

Won't be climbing fences again.

The last few times people from my family have gone to the emergency room with facial cuts (usually splits from falling against corners of things. Kids. So much fun), they've been glued rather than stitched.

When I had shoulder surgery a year and a half ago, they sutured the subcutaneous layers and glued the skin.

They use medical-grade superglue, in sterile mini-packs. It's battlefield medicine, apparently, coming into civilian use. This is in the Netherlands, so YMMV depending on location.

evilrooster said:

The last few times people from my family have gone to the emergency room with facial cuts (usually splits from falling against corners of things. Kids. So much fun), they've been glued rather than stitched.

When I had shoulder surgery a year and a half ago, they sutured the subcutaneous layers and glued the skin.

They use medical-grade superglue, in sterile mini-packs. It's battlefield medicine, apparently, coming into civilian use. This is in the Netherlands, so YMMV depending on location.

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When I almost cut my finger off that's what they used.

We've been using it on animals - particularly my experience has been with show horses where you don't want scarring.

NH_Doggy said:

Physician here

First- no way would a nurse stitch that up. It would be a physician, or perhaps a very, very well-trained PA. Is this story taking place in the USA? If so, chances are a plastic surgeon would be called in to do such a repair, since it's on the face and going up towards the eye, especially.

For facial lacerations where scarring is a concern, you would use very thin suture, and lots of stitches. I would guess we're talking about a 4 inch laceration here, so I'd guess a minimum of 20 stitches, perhaps more. If it was a very deep laceration, it would also likely be a layered repair, meaning that there is a layer of subcutaneous stitches that would dissolve, followed by a layer of superficial stitches.

Six stitches to close a laceration like you are describing would be medical malpractice.

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Actual Surgeon Here and No, scarring is proprtional to injury and sutures are a type of injury. You want to use the fewest stitches that properly hold the skin in place. It's actually common to only use a few stitches and then butterfly bandages. The healing is better although the wound will weep. Long term should be the rule.

Plain old guy here. Duct tape and whiskey will do fine.

Seriously, this will all depend on the wound. Neat slice from a scalpel or other sharp blade might be a half dozen stitches to pull the wound closed, bandaging for the rest. Slashed by beer bottle might be plastic surgeon time.

Wound depth can have a major effect on the choice. If it needs stitches, it's already pretty bad, but anything exposing bone, eye socket or possibly restricting muscle movement could be treated differently.

Age is another concern, younger girls might get plastic surgery quicker since they, in theory, need to retain beauty. Money/insurance can also affect this decision. The emergency room might even just pack the wound so she can visit her plastic surgeon elsewhere.

Bottom line, make up a reasonable number, give her the scar you want or need for the story and move on.

Jeff

WeaselFire said:

Plain old guy here. Duct tape and whiskey will do fine.

Seriously, this will all depend on the wound. Neat slice from a scalpel or other sharp blade might be a half dozen stitches to pull the wound closed, bandaging for the rest. Slashed by beer bottle might be plastic surgeon time.

Wound depth can have a major effect on the choice. If it needs stitches, it's already pretty bad, but anything exposing bone, eye socket or possibly restricting muscle movement could be treated differently.

Age is another concern, younger girls might get plastic surgery quicker since they, in theory, need to retain beauty. Money/insurance can also affect this decision. The emergency room might even just pack the wound so she can visit her plastic surgeon elsewhere.

Bottom line, make up a reasonable number, give her the scar you want or need for the story and move on.

Jeff

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Arrgh! Acht! Oy vey...Hate to admit it, but there is truth to that

When I had stitches in my knee, I remember I had to get a tetanus shot. I got the cut from falling off my bicycle, so I'm sure dirt was a concern. Also I was 10 years old, and I think I was scheduled to get a TD (tetanus-diphtheria) booster vaccine that summer anyway.

Don't know what (if any) shots I got after the second stitches (after my car accident). I was blissfully unconscious, and I was also receiving a bunch of other hard core drugs for other injuries, which I'm sure would have affected the treatment.

Hopefully some of the doctors in here can clarify!

suestrong315 said:

Ok, George, then would like 12 stitches do it? Would 6 still be medical malpractice? Should I shoot higher for, like, 15 stitches? Just a guestimate really...

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There is no stitch per linear inch requirement. You treat the patient. A sedentary adult with proper mentation who can be trusted to take care of a wound will be different than a child trying to shove crayons into anything that might open.

Pick a number and have some other character complain that it's too many or too few.

suestrong315 said:

Oh, oh also, since I am in the presence of medical professionals:

Since I'm no Dr and I wrote this when I was a teen and like House and ER were basically my references...

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Man did they suck

suestrong315 said:

They draw MC's blood to send to the lab to make sure the ring that cut her wasn't dirty with anything. Am I on the right track with that? If a golden ring with diamonds and a jagged edge cut someone in the face enough to need stitches, would you also do blood work to make sure there's no like, tetanus or anything?

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No, you simply vaccinate them. If you wait until someone is actually septic to treat them, there's a good chance that you waited too long

suestrong315 said:

Let's just get hypothetical for a second:

You're doing your rounds in the ER

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Surgeons don't do rounds in the ER. They go when called by the ER Physician

suestrong315 said:

and you get a 17 year old girl with a facial laceration from the corner of her nose up to the outer corner of her eye. The cut is deep enough to need stitches. What do you do from the time you walk into the room to the time you suture the laceration

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take a history, do an exam, check for foreign objects which may or may not involve X-Rays etc, numb the wound, wash the wound and sew

suestrong315 said:

(unless you so decide a plastic surgeon needs to do it) to the time the visit is over? Without going to the nurses station to fill out the chart, that's not important.

I ask because I introduce a character who's an interning nurse

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interns are physicians not nurses

suestrong315 said:

and he's there when the RN draws blood from the character. If I'm all turned around and wrong, then I need to rewrite the scene to reintroduce him a different way cause he shows up later in the story.

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