Gazette Vet: To Stitch or Not to Stitch

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By John Andersen, DVM

Summer is here, and one thing we are sure to see a lot more of at the veterinary hospital are cuts, bites, and wounds. Running through the woods, playing in the river, tussling at the dog park, dogs are like a bunch of rowdy kids, not always aware of their bodies until play time is over.

So here you are, on a Saturday afternoon just finishing up a long hike with your family dog, and you notice blood in the back of the car. After making sure the kids are all intact, you examine the dog, who now seems to have lost the invincible forest wolf energy she had just minutes ago, and now looks at you sadly and holds her paw up. You see a deep cut in the pad that at first glance makes you go “ewww.” What do you do? Rush to the veterinary ER? (Of which there are two in Charlottesville, thank goodness!) Clean it and wait until Monday, which is a long 36 hours away? Duct tape?

Here is my guide for dealing with these inevitable moments when also inevitably you’ve got soccer games, family travel, and a million other things to deal with!

Deal with it now. The most common “worst case scenarios” we see regarding cuts and wounds are ones that are brought to us 2-3 days after they happened, and are now terribly infected and much larger problems than they were a few days ago. Any time there is a cut deep enough to bleed, there is a break in the natural protective barrier of the skin and bacteria WILL enter—not just bacteria from the dirt, bite, etc., but also the bacteria that already live on the skin. We routinely see relatively small, but deep, cuts and punctures turn into very large areas of dead skin because of infection. Superficial wounds can be cleaned and treated topically at home, whereas deeper wounds likely need deeper cleaning and antibiotics to prevent infection. The key thing is it’s always better to deal with it now vs. in two days.

Superficial cuts and scrapes can usually be treated at home. Think of these as the “skinned knees and elbows”—not really a cut, but more an abrasion of skin. Just like cleaning your kid’s knee, treating your dog’s scrape is not very different, except that he is very hairy!! So, steps in taking care of these simple wounds:

• Get in good lighting!

• Clip or cut hair away from the wound—otherwise it will stick to the wound and foster infection and keep it from staying clean.

• Clean blood, debris, etc. from the wound and surrounding skin—a warm washcloth is good here, as is hydrogen peroxide. Note on hydrogen peroxide: while this is a good disinfectant, and is especially helpful when there is a lot of dried blood and goop on a wound, it does delay wound healing. So think of peroxide as Day 0 wound cleaning only.

• Apply antibiotic ointmen. Yep, bacitracin, Neosporin, etc.—all safe for kids, all safe for dogs too—even if they lick it a bit (which they will). Apply a thin layer on the wound and repeat a few times a day until it’s dry.

• Keep them from licking. Some dogs are totally cool, while others become a neurotic mess and start licking the heck out of any skin wound. They can certainly create a larger problem from their tongue and saliva, so if they are obsessing about it, you may need a cone collar or bandage.

• Only bandage if you need to. Bandages need to be placed with care—if too tight, they can cause swelling and tissue damage. If left on more than 12-24 hours on a new wound, they are just becoming a cozy home for bacteria to fester in.

Deeper cuts should be dealt with by your vet, ideally that day. There are many deeper cuts that we see that we don’t sew up—if the skin edges are close enough and there is not a lot of motion or skin tension, we may just clean it out and let it heal on its own. The key decision with these is whether it is deep enough to warrant an antibiotic or not. Remember, every wound is contaminated. If cleaned thoroughly within a few hours and if not too deep, it may not need antibiotics. However if not dealt with for over 4 hours, if deep, or if difficult to clean all the debris out of it, it may need some vet care for proper cleaning and antibiotics to keep it from getting infected.

Many cuts need to be sutured closed. For dogs who are calm we can do this in the office with no sedation, just a local block and a few staples or stitches. However many dogs need to be sedated because they are too scared, wild, or painful.

Punctures should always be seen as soon as possible. Bite wounds from a fight/scuffle with another dog/cat can become terribly infected because the teeth can sink deep below the skin, despite some very small skin wounds. Take a cat bite for example. This may cause only a 2 mm puncture wound in the skin, but that cat tooth may have sunk in ½” and is almost certain to be a painful infected mess in 1-2 days if not treated immediately.

Most puncture wounds will be cleaned out and placed on antibiotics—again, virtually all cat bites will become infected due to the nature of the bacteria that normally live in the mouths of cats. Not all dog bites will become infected, but the deeper ones usually cause enough tissue trauma that antibiotics are needed.

It’s not getting better. It’s important to see that the wounds are getting better, whether a simple scrape that you treated, or a dog fight wound your vet helped you with. Sometimes there is blood supply that was damaged at the time of the injury that will delay healing, or sometimes your pet has been licking at it. Check these wounds at least twice a day to make sure they are healing. I tell people the wounds should look more “boring” each day: less redness, less discharge, and less painful.

Get your pets out there and enjoy our area this summer, but when the inevitable accidents happen, simply ask what you would do if it was your own skin. That will usually guide you to the right action.

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