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Dr. Hive: how long to get stitches?


Laurie4b
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Dh took a chunk out of his knuckle tonight while using a saw. All the urgent cares are closed and he doesn't want to go to the ER and wait for hours while being exposed to flu, etc.

 

The cut isn't too bad--the problem is that it is on the knuckle. The cut is about 1 mm wide max, and about 1/2 inch long. I butterflied it shut, but I know being on the knuckle, it will keep popping open. An urgent care opens again about 9 hours after he injured himself. Will that be too long for them to do stitches?

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I'm wary to use a primary closure on anything that is more than eight hours old especially if it is on the hand. If your husband (hypothetically of course, especially since I don't have to work tomorrow) showed up in our ED tomorrow morning I would likely irrigate, explore, debride (if necessary), and then leave the wound open. If it looked good when rechecked in 48 hours it could be sutured then with a delayed closure. I would presume that most physicians would take a similar approach but perhaps in seeing the wound some might conclude stitches weren't needed at all and some might be so comfortable that infection risk was so low they were comfortable with a primary closure. I feel like I'm straddling too close to giving out medical advice which I don't want to do so I'll ask that you consider this information only and consult with a physician you trust who can actually see the wound and get the full story.

 

P.S. Don't forget to address whether a tetanus booster would be needed as well.

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I don't understand why it wouldn't be okay to stitch 9 hours later, but would be okay to stitch 48 hours later.

 

So he could just ignore it? If the doctors aren't going to do anything anyway, he wouldn't want to drive all the way to the urgent care in the morning and waste the time.

 

Does it matter if you have a cut on your knuckle if you don't mind the scar?

 

We cleaned it out with peroxide.

 

I would have considered gluing it shut, but figured being on the knuckle would keep the glue from holding.

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I had a cut on my finger close to the first knuckle. My first set of stitches became infected, and when the stitches were taken out the wound split wide open (9 days after the original stitching). At that point we switched to surgical glue and steristrips. I don't know if that would work for the knuckle itself though.

 

Your dh will have to keep the joint immobilized for a minimum of two weeks whether stitches or glue. If you don't have a splint, use a few popsicle sticks until you can get to the medical supply store. With my cut, I had to use a splint that extended over my entire finger down into the palm of my hand. For the first week I wrapped two fingers together in addition to having gauze around the palm/middle area of my hand with a loop of gauze around the wrist to hold it all steady. I also found it better to put a small gauze pad under the edge of the splint in the palm of my hand to keep that area from getting sore from the splint edges.

 

If you want him to have stitches, then you cannot glue it shut tonight. If you want to try the glue, then you must commit to the splint right away.

 

He will have to keep the hand dry. I bought a box of baby wipes and used those to clean my skin. I also used peroxide on cotton balls to clean. Each day I put Bacitracin on the skin around the cut (but not directly ON as this would make the steristrips come off). (I used Bacitracin because I am allergic to Neomycin--just use whatever triple antibiotic cream you have handy).

 

I don't know if the dr will even stitch it after such a long wait. A friend of mine who is an ER doc would not do so for a teen I knew when he split his eyebrow open. They glued instead.

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I should add--one concern with a cut on the finger is whether you may have knicked a tendon or have nerve damage. Before they would stitch me up the dr insisted on various movement tests and evaluated for numbness or pins-and-needles. The hand has a ton of that stuff, so it can be a real concern. This is the one reason you may want to see someone sooner rather than later.

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I don't understand why it wouldn't be okay to stitch 9 hours later, but would be okay to stitch 48 hours later.

 

 

I got a wound a few years ago and was not able to promptly get treatment for it. I was told by my doc that it needs to be stitched within the first 6 or so hours. Otherwise there is a much greater risk of infection (even if it's been cleaned and covered during that window). Like the OP mentioned, he suggested cleaning carefully and watching for a couple of days before stitching. By then it would be apparent if any infection was setting in. If not, they'd be able to stitch. You don't want to close an infected wound!

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