Cut my head open...
 

How do I know if I need stitches?

Its sunday, I'm in the back yard cutting a rather large branch off of an oak tree, I make my three cuts, then get off the ladder to let it fall, but its not moving, so I reach in and grab the end of the branch, and pull, it snaps, but I cant get out of the way fast enough, wammo, right on the right side of my head, knocked me down, I knew I was clobbered good, so I reached up and my hand was bloody, I felt around real good, nothing broken, just bloody, .. I've got an ice pack on my head right now, should I go get stitches or do I need them or?

Shit happens. guess its not too bad, my brother the 91W said he'd check it out later, he's shopping...

Couple of basic questions...

Do you have any blurred or double vision?
Do you feel dizzy or nauseous in any way?
Do you have any pain any where else...ie, neck, shoulder, back?
Do you have any tingling in your arms or legs?
Do you have any slurred speech? Can you say the following...."You can't teach an old dog new tricks." without sounding like a drunk?
Can you see what your pupils look like, by looking in a mirror? Does one look bigger, or smaller than the other?

If you can answer yes to any of the above, you might want to get checked out.

If not, it may just sound like, as you said, "clobbered yourself pretty good."

There are a lot of blood vessels in the head/scalp area, so even a small lacerations will bleed profusely. So that may be way you're seeing "lots" of blood.

But even still, if you're not quit sure, and your brother is going to be late......go get it checked out. Your brain bucket is nothing to take lightly.

A few things......can wash with baby shampoo and water in the shower, or ivory soap.
Feel for foreign bodies...need to be removed if present.
If laceration present, is it fully through the skin layer and you can see yellow fat at the bottom or the hair follicles? If so, 3 choices:
1) get sutured...do not let them cut your hair, just use surgilube to flatten the hair away from the lac and suture with blue monofilament (proline suture...blue is easier to see and remove),
2) if your hair is long enough, take some on each side of the laceration and tie it in a knot, first apply antibiotic ointment,
3) ignore it, let it get infected and give the local surgeon some business.......

ss

I'm all better
 

So, my bro finished shopping, came over with his aid bag, and said; "you need stitches." He cleaned me up, put on a pressure dressing and took me to the urgent care, 13 staples later I'm back at the house. .... Always wear a helmet when cutting big assed branches.

Staples? Are they afraid you're brains are going to leak out?

On a more serious note . . .

What is the factor that determines if you will get staples or stitches?

glad to hear you were cutting branches...i was afraid someone had erred and sent a cherry E7 the field grade do-it-yourself lobotomy kit...:D

Glad to hear you got stitched up and examined. Amigo, head injuries are nothing to ignore. I have many tales about bumps on the head that were ignored and resulted in death. Again glad you are fine!

On a scalp wound staples are quick, easy, and effective. Unless you are a "bald head" model, the frankenscar is pretty irrelevant because of the mop that traditionally covers it. I tend to avoid staples in blacks due to the close hair styles that are popular in that population and their scar is more in the open.

Other very large wounds (C-section) can also be optionally closed with staples. If there is a significant scar concern, plastics guys get involved with scar revision processes and procedures.

In general, the "better" you want to scar to look, the smaller suture material you use (strength of the suture for the site of injury is also a factor here) and the more time it is going to take to close it.

There are also various techniques to minimize scarring. The best cosmetic result is always considered-but areas like the face are generally given more initial consideration.

example:
I sewed a guys eyelid back together the other day and used 7-0 suture-about the diameter (and strength) of a human hair.

General face stuff usually 6-0, (maybe 2lb test fishing line)

Cuts on arms and such, 4-0 suture, like 6lb test fishing line

Large gaping wounds of legs and scalp that can be primarily closed (after closing the inner layers with absorbable suture)-skin closure by staples or heavier suture (10-12lb test).

SS Feel free to jump in here and monkey stomp my approach if needed:D

PA

You just shattered one of my long held beliefs . I have to admit :o I assumed the stapler came out for the indigent and sutures for the payers.

but but.. my stapler.... :D

Now, the question: Absorbable vs Nonabsorbable; where to use and when?

I've never used absorbable staples...

Eagle

:rolleyes:

I meant stitches... Never even heard of absorbable staples, don't know how that'd work.. lol

Are you saying that granulated tissue is not attractive??????

Think of the stories one could make up if they had a major scar running across the top of their head!

Jim

They do make absorbable staples...they suck!!!
Staples are quicker on the scalp...should have put that in my post also....I'm so used to instructing the residents on suturing technique and having them complain about wanting to use a stapler......my answer is: your grandmother can staple, a surgeon sutures......then we let them use the little machine as a reward.
It is a nice addition to a field med pack if you have the space for it.....I have used it in my tac-med world with an officer getting a wicked laceration of the forearm...washed, stapled, dressed and back in the thick of things in less than 2 minutes. Nice thing about staples it is so quick, don't absolutely need lidocaine....just staple. Feels like a nasty pinch but tolerable.....yes, we tried it on ourselves so I am speaking from first hand knowledge.

ss

Absorbable suture:
- To close deep layers of a wound when doing a multi-layer repair (ex: laceration to the forehead all the way to the skull). I usually use Vicryl for strength.
-Running subcuticular stitches to minimize stitch scar. Usually done with complex plastic repairs or closing surgical wounds. With the complex plastic repair, I'll revise the wound edges, close deep, do a running subcutic, and then a running 7-0 or 8-0 skin layer of absorbable sutures really close together to minimize tension on the individual sutures. Less tension = less stitch scar. Current dogma discourages subcuticular stitches in "dirty" wounds, since they may prevent draining of the wound.
- I'll use chromic gut on lips and face because there is less granulation around the suture material, leading to less stitch scar.
- If follow-up is a problem, and you don't think the patient can make it in to have their stitches removed, or if it's a child and you think they'll pitch a fit about suture removal because of where the stitches are or how they reacted to having them put in, I'll use absorbable.

Virtually everything else that is accessible: regular nonabsorbable suture, staples, "hair sutures", or superglue.


'zilla