Your Child Needs Stitches: Optimizing the Cosmetic Outcome

July 14, 2009

skin careMarin Mommies presents another guest post by Cheryl Huang, MD FACS, Board-Certified Plastic Surgeon and Marin mom.

Few of us have made it to adulthood without scars on our skin from childhood bobbles and falls. Though we all watch our children carefully, it’s likely that, at some point, your child will need stitches. Here are the answers to some important questions you should ask if your child requires stitches.

Q: What are some of the immediate things I should do at the scene of the injury?

A: STAY CALM… As a mother, I know that’s easier said than done. But one of the earliest skills I learned in my surgical training is that it is imperative to focus on the task at hand when you are the caregiver. Nix the emotional rage (“OMG, how is this going to affect her modeling career!” etc.). Rather, focus on delivering first aid. Apply direct pressure to stop bleeding. Of note, scalp wounds in particular can bleed dramatically due to their robust blood supply.

Q: What should I stock in my medicine cabinet?

A: Keep sterile gauze and sterile saline to moisten the gauze. You—and your child—will be very glad you moistened the gauze. It won’t stick to the wound when the physician removes it. Ace wraps come in handy if you are the only adult present and are driving your child to the doctor’s office or hospital; the wrap can be used to apply pressure to the wound.

Q: Any pointers specifically about lacerations to the head?

A: If your child has lost consciousness or experienced major trauma, go to the emergency room immediately. Be sure to report if you observe any drainage from your child’s nose or ears. Make sure there aren’t any loose or lost teeth and that a physician carefully checks your child’s neck and facial skeleton.

Q: Anything special to look for with regard to lacerations on the extremities?

A: A physician should assess the bones and joints in the vicinity of a laceration. An X-ray may be done. A comprehensive exam involves a survey of the strength (muscles), range of motion (tendons), sensation (nerves) and circulation (blood vessels).

Q: How should the laceration be repaired?

A: Small, superficial, linear wounds that are not under tension can be held together with Dermabond, a liquid skin adhesive. When wounds involve the deeper layers of the skin or are complex, sutures (stitches) should be used.

Q: What kind of anesthetic will my child require for the repair?

A: Judgment by the plastic surgeon will be based on your child’s age and the complexity of the wound. It can range from a couple of injections of numbing medication directly into the wound to conscious sedation to general anesthesia.

Q: How can we minimize the chance of infection?

A: Prompt wound closure is important. Irrigation before closure also is crucial to prevent dirt, bacteria, and foreign material from becoming trapped in the wound.

Q: At home, what can we do to help recovery?

A: For the first couple of days, you must prevent bleeding and tension on the newly stitched skin. Physical activity should be limited. Elevation of the involved area will decrease swelling. Be sure to report signs of infection (fever, increasing pain, redness, swelling, discharge) to your child’s physician. Make sure the wound is shielded from the sun, and watch the site carefully to ensure it does not become firm, red, or itchy. Some people are predisposed to forming thick, rope-like scars (keloids) and may require additional treatment.

Q: Do products like Mederma work?

A: The studies on this are not conclusive. A person’s genetic makeup has a stronger influence on how the scar ultimately will look. For most people, normal wound healing takes 12 to 18 months. Children generally heal quickly—and that is one saving grace we moms can appreciate!

Dr. Huang has served on the UCLA Clinical Faculty. During her 16 years of experience as a general surgeon and as a plastic surgeon, she has performed repairs of countless children’s lacerations. Her clinic, Marin Aesthetica, is located in Greenbrae in the suite with Women’s Medical Associates. For more information about Dr. Huang and her practice, go to www.marinaesthetica.com.