Cuts, Scrapes, Tears, and Punctures: Do I Need Stitches?
Moments after a skin injury, it is critical to make the right decision regarding medical care. While some wounds require immediate emergency care, others need to be evaluated at an urgent care center or can be safely treated at home. Prior to seeking medical care, individuals should take the following self-care steps:
- Apply pressure to stop bleeding
- Cover wound with a clean cloth or bandage
- Avoid attempting to remove embedded foreign objects
- If possible, cleanse the wound with clean water
- Assess wound length and depth
- Determine if a tetanus vaccine has been received within the last 5-10 years
Understanding the right treatment for different kinds of wounds will help individuals make appropriate decisions for seeking medical care, including tetanus vaccination and the potential need for stitches or other closure techniques.
Most abrasions or surface injuries to the skin do not require stitches. However, abrasions may require deep cleansing depending on the mechanism of injury and level of wound contamination. Seek urgent care treatment for an abrasion if the wound is:
- Unable to be cleaned well at home
- Contaminated with chemicals and/or contains foreign material
- Located on the face
- Bleeding continuously and cannot be stopped
Determining whether a puncture wound requires closure is dependent on the size and how the injury was sustained. Puncture wounds caused by stepping on a nail or misfire from a nail gun can pose serious health threats if not properly cleaned. These high-velocity injuries should be evaluated in the emergency department, where specialist referrals can be obtained if necessary. Low-velocity puncture wounds that are more than a few millimeters in depth should be evaluated at an urgent care clinic as soon as possible. If a foreign body remains embedded, allow a medical professional to remove the object. Seek medical care for a puncture wound if:
- The depth of the wound is unknown
- The depth is greater than 5 mm
- There may be a foreign object in the wound
- The puncture object is dirty
- The patient’s tetanus vaccine is not up-to-date
Most skin tears do not require stitches. Depending on the size of the wound and how much of the outer skin layer has sheared away, skin tears may have better outcomes if treated by a provider who specializes in wound management. Seeking professional wound care at an urgent care clinic within 24 hours of sustaining a skin tear is critical for proper healing.
Regardless of whether they appear contaminated or large enough to warrant stitches, bite wounds should always be evaluated by a healthcare provider. This includes bites from both domestic and wild animals. Delay in treatment can result in significant wound infections and skin damage.
Cuts frequently require stitches for healthy healing. If a wound is greater than one inch in length, some type of skin closure is likely. Facial and scalp lesions, even under one inch in length, will often require professional closure. Particularly with facial wounds, seeking medical care for cuts can help improve the cosmetic outcome. Providers can use a variety of tactics for closing wounds including traditional stitches, staples, skin glue, and steri-strips. It is important to keep in mind that most stitches must be placed within 18-24 hours of injury in order to limit the risk of wound infection. Seek medical evaluation if:
The cut is located on the face, scalp, hand, or over a joint
- Bleeding cannot be stopped
- Subcutaneous (fatty) tissue is visible
- The cut is greater than one inch in length
- The cut has jagged edges
- The cut is gaping
Sometimes, it is difficult to know whether to go to an urgent care clinic or the emergency department for wound treatment. The following table clarifies where to seek care based on the type of wound.
|Clean abrasion on the shin, arm, or torso without other injuries X||X|
|Contaminated abrasion X||X|
|Skin tear >1 inch X||X|
|Low-velocity puncture X||X|
|High-velocity puncture X||X|
|Cat, dog, or human bite X||X|
|Wild animal bite X||X|
|Any wound with embedded foreign body X||X|
|Cuts extending into subcutaneous tissue X||X|
|Cuts on face <2 inches X||X|
|Cuts on scalp X||X|
|Cuts on fingers/hand X||X|
|Cuts on lip X||X|
|Stab wounds X||X|
|Crush injuries X||X|
|Bullet wounds X||X|
Follow-up care for wounds will typically take place at a primary care provider’s office. This will include evaluation for signs and symptoms of infection, assessment of wound healing, dressing changes as appropriate, and removal of stitches or staples as indicated. Follow-up wound care is especially important for individuals with underlying health issues such as diabetes, impaired immune function, and bleeding disorders.
An urgent care clinic is often an ideal choice for wound care in the event of an injury. However, always consider the following when determining the appropriate medical care.
- Wound type
- Wound size
- Wound location
- Mechanism of injury
Kelly Coloff Bio
Kelly Coloff, FNP, has been an RN since 2002 and practiced as a nurse practitioner in primary care, urgent care, and dermatology since 2008. Kelly also enjoys reading and spending time outdoors with her family.