Here’s How You Know If You Need Stitches, Says an Emergency Room Doctor

Life isn’t short on sharp edges—and whether you’ve had a kitchen mishap, a fall, or another accident entirely, the sudden panic from a fresh wound can make it hard to know whether you need stitches.

Matthew Mostofi, DO, Associate Chair of Emergency Medicine at Tufts Medical Center, says many skin injuries will heal on their own. Still, in some cases, stitches are medically necessary.

Below, Dr. Mostofi explains how to tell whether you need stitches, and when to seek medical care.

What stitches actually do

“Stitches are there to hold damaged tissue together in the right anatomic position,” explains Dr. Mostofi. Bringing the edges of the skin together properly encourages efficient healing, maximizes return to full function, and minimizes any cosmetic defects, such as scarring.

Sealing up a wound with stitches also reduces the risk of potential complications, including infection. “The longer a wound is open, the more ‘bacterial colonization’ of the wound occurs,” Dr. Mostofi says.

How do you know if you need stitches?

After getting a skin injury, Dr. Mostofi says to try and stop the bleeding by applying direct pressure on the wound. “When this is achieved, cleaning the wound under a clean water faucet stream will reduce infection risk,” he says. “This is a good time to inspect the wound.”

At this point, look out for a few red flags that could suggest you need to see a medical professional for stitches:

• The wound is longer and/or deeper than a half-inch.
• There’s still uncontrolled bleeding after applying pressure.
• The edges of the wound won’t close easily and/or it has jagged edges.
• You can see fat (a yellowish color), muscle (a pink or reddish color), bone, or tendons.
• You feel numbness or loss of full function around the wound area.
• Location matters, too. If you get a cut near a joint area, like in your wrist, knee, or elbow, your doctor will want to evaluate the wound to ensure there’s no further damage. The same is true for more delicate areas of your body, such as a significant injury to your ear, nose, or the inside of your mouth, Dr. Mostofi says.
• In addition, “anyone who has a high risk for complications [should seek care],” he emphasizes. This includes individuals on blood thinners or those with blood clotting issues (coagulopathy), people with diabetes, people with neuropathy (nerve damage), and those with weakened immune systems (immunosuppression).
• But there are some cases when you should seek medical attention for a wound even if these red flags aren’t a factor. For example, if your skin injury was caused by something dirty, rusty, or an animal, your doctor will want to check it out. It’s important that these wounds are treated to ensure they’re clean and infection-free. Depending on the situation, your doctor may also want to take action to prevent complications, such as giving you a tetanus shot.
• “There are circumstances when a small cut should also be considered for repair,” Dr. Mostofi adds. “For example, a small cut on the lip border may have a poor cosmetic result.” A cut in an awkward area may also benefit from stitches. “For example, on the bottom of your foot or in a very functional area like your hand that will make bandaging difficult and healing delayed.”

What happens if you don’t get stitches

“Delay in wound repair can increase the risk of infection, prolong healing time, and result in a worse cosmetic appearance,” Dr. Mostofi says.

“The most important thing to remember is that there is a time limit for primary wound closure,” he emphasizes. “In general, most skin and soft tissue wounds will not be closed after eight to 12 hours after the injury. So, if you think you might need stitches, it’s best to seek care early.”

This is especially true for wounds that ER docs want to evaluate and treat as soon as possible. “There is concern for the wound damaging any structures that are deep,” Dr. Mostofi explains. These possible complications can include:

• A cut that affects a tendon in the foot or hand
• An intrusion into a joint space, such as the wrist, knee, or elbow
• Involvement of a major vein or artery
• Involvement of a nerve, which can lead to numbness or weakness

Stitches vs. alternatives

Stitches might bring to mind Frankenstein-style skin sewing—and that’s one approach your doctor might take. But there are several different options to close up skin wounds. A doctor can determine which is right for your injury based on its severity, location, and type of cut.

Non-absorbable, sewn-in sutures are what most people are likely familiar with. Dr. Mostofi says that this type of suture needs to be removed by a medical professional once the wound heals, and there are a few different forms. These include natural non-absorbable sutures using silk from a silkworm, synthetic-polymer sutures derived from chemical sources such as nylon or Prolene, or surgical staples made from steel.

Absorbable stitches are another option that “dissolves” in the skin, so they don’t need to be removed. According to the National Institutes of Health, absorbable sutures are most often used:

• When there’s no need for high-strength support
• Your doctor suspects the wound will heal quickly
• If you require internal stitches
• For injuries in delicate areas susceptible to scarring, such as the face

Still, Dr. Mostofi says that some wounds benefit from non-suture wound closures, which include:

• Surgical tape, such as Steri-strips or butterfly bandages
• Tissue adhesive or glue
• Novel adhesive strips and devices, such as Clozex, Dermaclip, or Zip Stitch

What to do before you get medical attention

As Dr. Mostofi explained, as soon as you cut yourself:

• Apply direct pressure on the wound to control bleeding.
• Clean the wound with water to minimize infection risk (avoid products like iodine, rubbing alcohol, or hydrogen peroxide).
• Assess the wound for signs that indicate you may need stitches.

“If it is very large, deep, bleeding is not controlled, may affect other structures, or you’re at high risk for complications, then you should consider seeking care for wound closure evaluation,” he advises.

“Just place a clean, dry dressing on the wound, [apply] enough pressure to control bleeding, and come to the emergency room or urgent care.” That’s it! Don’t try to close the wound yourself—and if there’s debris, dirt, or other objects in your wound, leave that for a medical professional to take care of as well.

Remember that it’s always okay to get a wound checked out, even if you’re not sure that you need stitches. A cut that doesn’t look that bad might still affect a tendon or nerve, and waiting too long for treatment can lead to complications. Even small cuts or wounds in awkward places often heal better when stitched up. So when in doubt, it’s best to see a healthcare provider.

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