In this subreddit we get a lot of posts asking whether something needs stitches or not including self harm posts which are quickly deleted as per the r/firstaid rules. In this post I'll go over when a wound would need stitches or when it can be managed at home.

A lot of the posts in here, especially the self harm posts that are deleted, clearly need stitches as the edges of the wound are gaping open. The short answer is if the edges do not touch (which is typical with cuts made by a sharp object) it will require some sort of stitches.

When I say stitches I'm also taking about all types of skin closures they may do at the hospital including glue and wound closures.

Here is an example (NSFW this is a picture of cut skin)

As you can see the edges of the wound are not touching and it is gaping open. These need stitches.

When do I need stitches

• Wounds that are more than 6 mm (0.25 in.) deep, that have jagged edges, or that gape open.

• Deep wounds that go down to the fat, muscle, bone, or other deep structures.

• Deep wounds over a joint, especially if the wound opens when the joint is moved or if pulling the edges of the wound apart shows fat, muscle, bone, or joint structures.

• Deep wounds on the hands or fingers.

• Wounds on the face, lips, or any area where you are worried about scarring (for cosmetic reasons). Wounds on the eyelids often need treatment for both functional and cosmetic reasons.

• Wounds longer than 19 mm (0.75 in.) that are deeper than 6 mm (0.25 in.).

• Wounds that continue to bleed after 15 minutes of direct pressure.

(https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=sid42906)

Is there a time limit to stitches

Ideally as close to when you received the injury as you can but typically up to 24 hours.

When do I not need stitches

When the wound is not open or gaping open, cuts that are not deep, or types of injuries that do not cause the edges of the wound to open and close through movement. Wounds with smooth edges that stay together during normal movement of the affected body part.

• Shallow wounds less than 6 mm (0.25 in.) deep and less than 19 mm (0.75 in.) long.

• Most puncture wounds

(https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=sid42906)

Example:

As you can see the wound is not gaping open and moving the part of the body that is injured does not cause the wound to open up or start bleeding again.

No access to health care or insurance/self treatment options

If you do not have health care insurance, don't have access to free health care, have limited health care options, or have financial barriers preventing you from seeking health care it is understandable that you may be resistant to seeking medical treatment. If the cut is small, wound closures may help. For larger gaping wounds(lacerations), there is often too much tension to overcome for at home wound closure kits. For gaping wounds, the body will use scar tissue to fill the gap which will create a visible scar.

For wounds that need stitches, you risk further injury, scaring, infection, and complications that could end up costing you more money.

Self harm/fear of going to the hospital

A lot of self harm injuries caused by a sharp object need stitches. Typical self harm locations usually have some tension to the skin so if you cut too deeply it is more likely to gape open and will usually not close with at home wound closures.

If you have a self harm injury and you cut yourself deeper than you intended it usually needs stitches. Nearly 100% of the posts I see connected to self harm are large gaping injuries that more than exceed the criteria listed above for stitches. People who cut themselves often will typically know they went too deep and that is why they are asking for help. For large self harm injuries, not going to the hospital means you will have a large scar in that spot for the rest of your life as the spot will be filled in with scar tissue. Scar tissue is a different colour than your skin and will be visible. If the edges of the wound can be connected through stitches then only the small line of the laceration will be visitable and these have a higher chance of fading. In addition, without treatment, you may have complications such as an infection which will require longer care.

Some people have a fear that the hospital will force them to stay there or get them in trouble. Medical professionals see a lot of self harm injuries and it is up to you what you want to disclose to them. Medical professionals are more concerned about injuries if injuries are connected to a suicide attempt rather than non-suicidal self harm injuries. You can also have a chat with a local crisis line, children's help line, or other help lines in your area about what a visit to the hospital will look like so you can prepare yourself for it.

It is always worth it to be seen for larger wounds and you can go to the hospital by yourself or with a friend if you have a safe way to get there. You can also Google smaller clinics and health centres that may be near your house as any doctor can do stitches - it does not have to be an emergency department.

Tetanus vaccine

If you cut yourself or created an open wound and it's been longer than 5 years since your tetanus shot, you should consider getting one. Routinely the vaccine is recommended every 10 years. You are at higher risk if it's an unclean object or outside.

"Adults who were immunized against tetanus and diphtheria when they were younger should get a booster dose of the Td vaccine every 10 years. This strengthens or boosts the immune system to give better protection against these diseases.

Adults who have not been immunized or do not have a record of prior immunization should also get the vaccine. The vaccine may also be given to people with serious cuts or deep wounds if their last tetanus vaccine was given more than 5 years ago."

(https://www.hpepublichealth.ca/wp-content/uploads/2022/08/IMM-53-Td.pdf)

I'll leave the comment section open so people can ask more questions or post their own information.