Wound Closure and Wound Care

What is wound closure?

Wounds heal more quickly and with less risk of infection and scarring when the wound is cleaned and the wound edges are held together (closed). Scrapes, scratches, puncture wounds, and shallow cuts may need only cleaning, ointment, and a bandage. Some cuts may need to be closed with tape strips called Steri-Strips or tissue adhesive spray (skin glue). If a cut or surgical incision is deep, very long, jagged, or under a lot of tension (such as a cut over a joint), stitches (also called sutures) or staples may be needed to close the wound.

How do I take care of my wound and sutures?

If you get an accidental cut, put pressure on the wound with a gauze pad or clean cloth right away to stop the bleeding. Then gently but thoroughly wash it with soap and cool water. Soapy water can be used around, but not in the cut. Try to remove all dirt and debris but do not scrub vigorously. If you decide to get medical treatment, cover the wound and apply pressure as needed to control bleeding while traveling to your healthcare provider's office, urgent care clinic, or emergency room.

After a wound is closed by your healthcare provider, the wound and the area around it must be kept clean and dry. The care of a stapled wound is similar to the care of a sutured wound. There are minor differences in caring for a wound with adhesive film.

• Do not let a wound closed with stitches or staples get wet for the first 24 hours. After 24 hours, you can shower or you can clean the wound with hydrogen peroxide or gently wash it with soap and warm water twice a day.
• If your wound was closed with adhesive film, keep the wound dry for the first 4 hours after the adhesive film was put on. After the first 4 hours, you may occasionally and briefly wet the wound in the shower. You can clean the wound with hydrogen peroxide or gently wash it with soap and water twice a day.
• If your wound is closed with Steri-Strips, they may be more likely to separate if they get wet. Keep this in mind when you clean the wound and shower.
• Do not soak or scrub the wound. Do not take a bath, go swimming, or use a hot tub.
• If recommended by your healthcare provider, you may put a small amount of antibiotic ointment on the wound each time you clean it. This doesn't help the wound heal faster but may prevent infection. It will also help keep bandages from sticking to the wound. If a rash appears, stop using the ointment. If your wound is closed with skin glue, do not put liquid, antibiotic ointment, or any other product on the wound while the adhesive is in place. It may loosen the film before the wound is healed.
• Make sure the wound is kept dry between washings. After showering or bathing, gently pat the wound dry with a soft towel.
• Your healthcare provider may recommend that you cover the wound with gauze or a new, bandage to keep it from getting dirty. Be sure to keep the bandage dry. Put on a new bandage after cleaning the wound of if the old one gets dirty or wet.
• Your healthcare provider may recommend leaving the wound "open to air" and not covered by a bandage while you sleep to help speed up the healing process. If the wound was closed with skin glue, you do not need a bandage.
• For the first 1 or 2 days keep the area propped up higher than your heart. This will help lessen your pain and any swelling.
• Protect the wound from repeat injury until the skin has had time to heal.
• Protect the wound from a lot of exposure to sunlight or tanning lamps while adhesive film is in place. Wounds exposed to the sun can become red, while scars that have not been exposed to the sun usually turn white after a period of time.
• Do not scratch, rub, or pick at your stitches, staples, or adhesive film. This may cause them to loosen before the wound is healed.
• Avoid activities that will make you sweat a lot until the adhesive has naturally fallen off or the stitches or staples have been removed.

Any wound can become infected. When you are cleaning your wound, look for these signs of infection:

• Increased redness
• red streaks
• increased swelling
• increased pain or tenderness
• pus or other drainage
• warmth in the area of the wound
• fever.

Contact your provider if you see any signs of infection.

If your wound was accidental, be sure to ask if a tetanus booster is needed. Treatment of accidental wounds may include taking an oral antibiotic to help prevent infection. Be sure to take the medicine until it is completely gone. Do not stop taking it just because the wound looks like it is healing well.

When are stitches, staples, or other types of wound closures removed?

Steri-Strips are usually left on until they fall off. If they have not fallen off after 2 weeks, they should be removed. Adhesive film usually falls off on its own in 5 to 10 days.

For deep cuts the first stitches are placed under the skin. These stitches are made of materials that dissolve and do not need to be removed. Sutures or staples on the surface of the skin need to be removed by your healthcare provider 5 to 14 days after they are put in. The length of time depends on where the cut is. Sutures in wounds on the face usually can be removed after 5 to 7 days. In areas of high stress, such as hands, knees, or elbows, the sutures must stay in 10 to 14 days. Your provider will tell you when you should come to the office for removal of your sutures or staples. Do NOT remove sutures or staples yourself unless your provider instructs you to do so.

WHEN SHOULD I CALL MY HEALTHCARE PROVIDER?

Call your provider right away if:

• You start to have any signs or symptoms of infection. These include:
  • Your skin is redder or more painful.
  • You have red streaks from the wound going toward your heart.
  • The wound area is very warm to touch.
  • You have pus or other fluid coming from the wound area.
  • You have a fever higher than 101.5° F (38.6° C).
  • You have chills, nausea, vomiting, or muscle aches.
• The wound seems to be opening up or you notice any drainage.
• The wound bleeds for more than 10 minutes.
• The stitches or staples are loose.
• The adhesive film is loosening before it is supposed to.
• You have any symptoms that worry you.