Stitches, medically known as sutures, are specialized threads used to bring the edges of a wound together. Their primary purpose is to hold the damaged tissue firmly in place, acting as a temporary scaffold while the body initiates its healing process. By aligning the skin layers, sutures accelerate healing and provide structural support. This manual approximation of wound edges is a method known as primary intention healing.
Criteria Determining the Need for Stitches
The decision to close a wound with sutures is based on characteristics suggesting the injury will not heal optimally on its own. A primary factor is the depth of the wound, especially if it extends past the superficial layer of skin (epidermis) into the deeper dermis or underlying tissue. Wounds deeper than about a quarter-inch, or those where the edges gape open, typically require closure.
The location of the injury is also a significant consideration, particularly for areas under high tension or with cosmetic concerns. Wounds over joints, such as the knee or elbow, are prone to reopening with movement, which delays healing. Lacerations on the face, lips, or hands are often closed to minimize scarring and preserve function. The mechanism of injury matters, as jagged, irregular cuts or those from crushing forces are harder for the body to close naturally compared to a clean incision.
Acute Risks of Unclosed Wounds
Leaving a significant wound unclosed exposes the body to immediate dangers, with infection being the most prominent risk. A gaping wound provides an open entry point for environmental bacteria to enter and multiply in the underlying tissues. This uncontrolled bacterial presence can rapidly lead to localized infections like cellulitis or an abscess.
If the infection progresses, bacteria can enter the bloodstream, potentially leading to systemic complications like sepsis. Sepsis is a life-threatening response where the body’s immune system overreacts, causing widespread inflammation that can damage organs. Another immediate concern is hemorrhage, or excessive bleeding, especially if the wound severed a major blood vessel. Furthermore, a deep, open wound is harder to clean effectively, allowing foreign material to remain trapped, which increases the risk of infection.
Long-Term Healing and Scar Formation
When a wound that should have been sutured is left unclosed, it heals by a process called secondary intention. The body must fill the entire wound cavity with granulation tissue, which consists of new connective tissue and tiny blood vessels, before skin cells can migrate across the surface. This method is substantially slower than primary intention healing, which relies on the manual closure of the edges. The resulting scar is often far more noticeable, typically appearing wider, thicker, and more irregular than a sutured wound.
The extensive tissue generation and wound contraction required during this process can lead to a scar that is raised (hypertrophic) or depressed (atrophic). Uncontrolled contraction can cause functional impairment, particularly if the injury is near a joint. Healing by secondary intention can take several weeks or months to fully close. The resulting scar tissue takes 12 to 18 months to mature and reach its maximum strength, which is still only about 80% of the original skin’s strength.