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Is suturing or steri-strip required as per the attached reports?

Answered by
Dr.
Dr. Ishu Bishnoi

Neurologist, Surgical

Practicing since :2007

Answered : 830 Questions

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Posted on Fri, 13 Oct 2017 in Lump
Question: Hi Doctor,

my son is 7 years old, today while in swimming pool he fell on his head and he got a cut on his right forehead just above the below the eyebrow above his eyelid.

I checked the wound, it doesn't seem to be to deep even though i can see some adipose tissue and at one place at the center i can see one hole that's slightly deep.

I decided not to take him to hospital and just treat him at home.
I got Fenosidine cream, and wound cleaner as well as steri-strip , i cleaned his wound, applied the wound cleaner, and then attached the Steristrip crossectional to the wound.
It's been almost 8 hours from the time he got the wound, i decided to wait until tomorrow and see how it will be . i'm still not sure if i should take to hospital for suturing.

questions,
1.according to the pictures i sent you, do you think suturing is necessary or the steristrip is enough
2.my main reason i don't want to take him to apply stiches is the scar that's left at the end, do you think using just sterstrips according to the wound size might even lead to a bigger scar? or is it better that i use only steristrips?
3.what else do you suggest me to do?

images uploaded.
doctor
Answered by Dr. Ishu Bishnoi 1 hour later
Brief Answer:
Treatment of wound

Detailed Answer:
Hi XXXXXXX thanks for asking from HCM.


I can understand your concern. It is sad that he is having wound over face. You are concerned about "cosmesis". In old time, people used to treat facial wound with thick silk interrupted sutures. These sutures used to give ugly dotted scar on both sides of main wound just like :::::::

But nowadays, the suturing is done with very fine nylon suture and "subcuticular suture technique" is used. This technique does not give ugly scar like interrupted sutures. The scar will be approximated very well.

After seeing the images, I can say that wound was subcutaneous deep. Such kind of wound needs suturing. Only applying steristrip is not sufficient.

Another method to avoid suturing is using subcutaneous sutures inside wound and approximating skin with "skin glue". Skin glue does not give any scar of its own.

My advise is to go to hospital and ask doctor about above mentioned options. You will get best cosmetic result.

If any doubts, do let me know. Hope it will help.
Thanks. Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ishu Bishnoi 10 hours later
Hi Doctor,

Thanks for your quick response and detailed explanation of the case.

I want to ask you Doctor it's now been 18 hours since my son got injured. and it's approximately 9 hours since i applied the steristrips on him .
I looked at the injury now and it seems like he is already recovering, scar tissue slightly forming, the wound seems closed and dry.

I uploaded new pictures of the results i see now, kindly check carefully and try to zoom in, let me know if you need better quality images.

Questions.
1.do you think he is till need suturing? or now it's too late for suturing?
2.will this kind of healing leave bigger scar for the future on his face?
3.if suturing is not needed, i'm thinking to remove the steristrips and reapplying it again by trying to draw the wound closer to each other as you can see there is slight separation of the two skins at the top, should i do that or just leave the strips there for few days?
doctor
Answered by Dr. Ishu Bishnoi 7 minutes later
Brief Answer:
Need pictures, not uploaded yet

Detailed Answer:
Hi XXXXXXX welcome back.


I checked the attached files. It does not have new picture. The formed two pictures are there only. Please upload again.

Thanks.

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ishu Bishnoi 13 minutes later
hi doctor sorry i forgot to upload.

kindly check now .
doctor
Answered by Dr. Ishu Bishnoi 11 minutes later
Brief Answer:
wound approximated

Detailed Answer:
Hi XXXXXXX thanks for uploading the images.


You have applied the strips very well. The wound margins are almost approximated. But due to edema at edges, small part of wound (fatty tissue) can be seen. If suturing would have been done, it would have completely closed it. As more than 8 hours have passed, subcuticular sutures can not be applied now. However delayed primary closure can be done with interrupted sutures.

If you are too much concern with scar, then you can go for it. Otherwise, no need to do anything. The wound has been approximated very well.

2) answer - The scar will be not too big. It will be of around 3-4mm thickness as compared to subcuticular suturing scar which is around 1mm thick. Good thing is - it will be partially covered in his eyebrow hair.

3) answer - You can reapply the steristrip only in that part where some subcutaneous tissue is visible. It is just to decrease the scar size. Approximation is already done by you.

Hope I have answered your queries. If still there is doubt, please let me know.
Thanks. Take care
Above answer was peer-reviewed by : Dr. Nagamani Ng
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