Stitches and Scars

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• Stitches
• Scar Care

Stitches

There are two types of stitches: dissolvable and non-dissolvable. Dissolvable stitches will go away on their own with time. Non-dissolvable stitches require removal when the wound is healed. With the rare exception, The Plastic Surgery providers at ETCH only use dissolvable stitches.

How to take care of external dissolvable stitches:

• For the first week, clean the stitches once a day with a solution of watered down hydrogen peroxide (1:1). Tap water is fine. Dip a Q-tip in the solution and then gently roll the Q-tip over the stitches to remove any crust and debris. Do not pick or scrub off the crust.
• For the first week, keep the stitches slimy with an over-the-counter antibiotic ointment. You do not need a prescription ointment. We generally recommend bacitracin. You will need to apply it 3-4 times a day to keep the string from drying out.
• After the stitches have been in place for a week, you can begin washing them daily with mild soap and tap water.
• Any child is capable of picking out stitches, so do your best to keep your child from touching the wound.
• If you choose to cover the wound with a bandage, be sure to change the bandage at least once a day to keep the wound clean.
• Dissolvable stitches should be gone between 7-10 days. If you still see strings in place at 10 days, soak the strings in a bath or shower and use a washcloth to scrub them out.

How to take care of non-dissolvable stitches:

• From the time they are placed, you may wash them gently that first week with mild soap and tap water.
• For the first week, apply over-the-counter antibiotic ointment twice a day.
• Any child is capable of picking out stitches, so do your best to keep your child from touching the wound.
• If you choose to cover the wound with a bandage, be sure to change the bandage at least once a day to keep the wound clean.
• Removal of non-dissolvable stitches depends on location on the body. Your provider will tell you when to return to the office to have them removed.

When can my child return to sports or swimming after receiving stitches?

• Sports: in general, after 2 weeks. This may be extended depending on the severity and location of the wound.
• Swimming: in general, after 1 week in a personal chlorine pool, after 2 weeks in a public pool, and after 4 weeks for the ocean, lake, or any -other natural body of water.

What if the stitches pop open (also called “wound dehiscence”)?

While rare, sometimes stitches can break too early. If the stitches were placed within 24 hours, call the Plastic Surgery office: 865-824-4939. If it has been more than 24 hours since the repair, it will simply have to heal on its own. We will want to evaluate the wound in the office 2 weeks after the stitches popped.

Wound healing timeline:

In general, it takes 1 year for a wound to completely heal. Therefore you will know the final appearance of a scar at 1 year after the injury. The typical wound healing timeline is as follows:

• First 1-2 weeks: the wound will ooze and lay down a scab. It will also bring in collagen and a new blood supply giving it a reddish appearance.
• 2 weeks to 3 months: By now the scab is generally gone and the wound will appear reddish or dark pink. The skin will also look raised or puffy. This is normal and it is not the final appearance of the scar. You will begin *** scar care at two weeks after the injury.
• For the next 8-9 months: by now the wound is healed and the body will start to remodel the scar. This will reduce the reddish discoloration and the skin will smooth and flatten out. This process is generally complete at 1 year after the injury to the skin. You will continue applying moisturizer and daily sunscreen through 1 year.

Scar Care

A scar is laid down within the first two weeks after an injury to the skin. From two weeks on, scar care is critical to the final appearance of a scar. The final appearance of a scar is at 1 year after the injury. This includes surgery, which is a controlled injury to the skin.

Starting at 2 weeks after the injury, you will need to do two things for the next year:

1. Apply a daily moisturizer.
2. Protect the wound from sun exposure.

Moisturizer helps keep the skin soft so it can heal well. Moisturizer can include anything from grandma’s old remedies of vitamin E and cocoa butter, to name brand scar solutions like Mederma (which is simply a moisturizer). You can also use things like Vaseline/petroleum jelly, Aquaphor, Eucerin, Aveeno baby lotion, Cereve, or any other plain, unscented moisturizer. One of the best moisturizers for reducing the appearance of scars is silicone. It can be purchased in a gel, roll on, or stick-on patches. Silicone can be purchased in most any store that sells regular wound care items, or you can purchase it online.

The KEY is not the brand of moisturizer you use, but that you use it every day.

Sunscreen is the mainstay of sun protection. Exposing a scar to sun during that first year can permanently stain the skin. In order to minimize the appearance of a scar, sun protection is imperative. We recommend using a mineral based sunscreen which include zinc oxide or titanium dioxide. The “oxide” portion of the sunscreen ingredients should equal 20% or more. Sunscreen should be applied to exposed skin any time you are going outside, even in the winter months. Always reapply sunscreen every 2 hours when outside for prolonged periods of time. Again, sunscreen should be applied for a year after the injury to minimize staining of the skin.

Other forms of sun protection can include hats, sun shirts, long pants, silicone patches, a bandage, etc.

What if I do not like how a scar looks at 1 year?

While there is no “magic eraser” after a scarring injury or surgery, scar revision and laser therapy are two modalities that can be used to reduce a scar’s appearance when it has been a year or more since the injury. If you have concerns, please call the Plastic Surgery office and we will be happy to evaluate and discuss what may work best for your child: 865-824-4939.