Stitches, formally known as sutures, are a medical technique used to close wounds and promote healing. This procedure involves using specialized thread and needles to hold the edges of a laceration together. Proper wound closure minimizes the risk of infection and ensures the best cosmetic outcome by aligning the skin edges to reduce scarring. The decision of who performs this procedure and where depends on the complexity of the injury and the professional’s training.
Licensed Healthcare Providers Trained in Suturing
Many medical professionals are licensed to perform wound closure, with competence determined by their education, certification, and scope of practice. Physicians in fields like emergency medicine, general surgery, and plastic surgery perform the most complex repairs, having received extensive training during their residencies.
Physician Assistants (PAs) and Nurse Practitioners (NPs) are highly capable mid-level providers who routinely perform simple and intermediate suturing in clinics and emergency settings. Their training typically includes dedicated workshops and hands-on clinical experience. Even some Registered Nurses (RNs) in specialized roles, such as Registered Nurse First Assistants (RNFA) or those with advanced wound care training, are permitted to perform basic suturing under specific protocols or physician supervision, depending on state regulations.
Specialized practitioners like dentists and oral surgeons are also extensively trained in suturing, focusing on the delicate tissues of the mouth. The medical classification system recognizes this range of procedures through Current Procedural Terminology (CPT) codes 12001 through 13160. These codes categorize wound repair based on complexity: simple (single-layer closure), intermediate (layered closure of deeper tissues), and complex (repairs requiring extensive debridement or special techniques). This coding system reflects that suturing is a recognized skill across many licensed specialties.
Clinical Environments Where Sutures Are Performed
The location for wound repair is based on injury severity and available resources. For minor, straightforward lacerations that are clean and do not require deep tissue repair, an Urgent Care Clinic is generally the appropriate setting. These centers are equipped to handle simple wound closures and often offer shorter wait times than a hospital.
In contrast, the Emergency Room (ER) is reserved for wounds that are more severe, complex, or involve deeper structures. This includes lacerations with uncontrolled bleeding, those that expose bone or tendon, or wounds that may require X-rays or specialized surgical consultation due to potential nerve damage.
Primary Care or specialist offices, such as a dermatologist, will occasionally handle minor, uncomplicated repairs or manage post-procedure care like suture removal. They typically refer acute, traumatic injuries to higher-level facilities. The resource availability, including access to advanced imaging and operating room capabilities, dictates which setting can safely manage a particular injury.
Non-Suture Wound Closures and Unlicensed Practice
Not all wounds require traditional thread sutures, as licensed practitioners have several effective alternatives for closure. Medical adhesives, often called skin glue, are a popular option for small, clean lacerations, especially on the face, as they are fast and minimize scarring. Surgical staples are frequently used for linear wounds on the scalp or trunk, where they offer a quick closure for areas with less cosmetic concern.
Adhesive strips, commonly known as Steri-Strips, are used for superficial lacerations with minimal tension or to provide added support after the removal of traditional stitches. These alternatives are preferred for their speed and lower risk of needle-stick injuries, but they are not suitable for deep, contaminated, or high-tension wounds. Individuals without professional medical training should never attempt to suture a human wound. Improper closure can trap bacteria, leading to a severe infection or abscess, and poor alignment of the skin layers will significantly worsen scarring.
Criteria for Determining the Need for Stitches
The decision to seek professional medical attention for wound closure should be guided by several specific characteristics of the injury. A gaping wound, where the edges do not easily come together with gentle pressure, typically requires stitches to heal properly. Lacerations deep enough to expose underlying fatty tissue, muscle, or bone indicate a need for immediate medical evaluation, as deeper structures may be involved.
Wounds on certain body parts, such as the face, over a joint, or on the hands, should be seen by a professional due to the increased risk of scarring or functional impairment. Bleeding that is difficult to control—specifically, any bleeding that continues after 10 to 15 minutes of firm, continuous pressure—requires immediate care. Furthermore, wounds that are heavily contaminated, such as those caused by animal bites or rusty objects, need professional cleaning and often a delayed closure or antibiotics to prevent deep-seated infection. Most lacerations requiring closure should be cleaned and closed within a critical window, often referred to as the “golden period,” which is typically six to eight hours from the time of injury.