Which wounds need stitches, which can you dress yourself, and the signs of infection

Which wounds need stitches

The time limit exists because skin bacteria multiply in the wound over time. A wound closed after 6–8 hours traps them inside and easily becomes infected. The face is the exception: where the blood supply is so good that closure is acceptable up to 24 hours. Past the window, the doctor may clean the wound and let it heal from the inside instead, which takes longer and scars more.

Which wounds can be managed at home

• Shallow grazes that ooze but do not run, such as a scraped knee
• Shallow cuts whose edges sit together on their own, no longer than 1–2 cm, and not on the face or over a joint
• Unbroken blisters from shoes or a minor scald
• Wounds with no foreign material (glass, grit) that will not wash out

Good to know: Even a small wound should be seen by a doctor from the start if you have diabetes, poor circulation, take immunosuppressants, or the wound is on the foot. These wounds infect easily and heal very slowly.

Dressing a wound properly

• Wash your hands, then stop the bleeding by pressing firmly with a clean cloth for 5–10 minutes without peeking
• Rinse the wound under clean running water (drinkable tap water or saline) long enough to flush out dirt, and wash around it with mild soap
• Do not pour alcohol or hydrogen peroxide into the wound; they damage healing tissue. Dilute povidone-iodine can be applied around the edges
• Never use toothpaste, tobacco, fish sauce or herbal poultices: they add infection and make the wound hard to assess
• A thin layer of antibiotic ointment is fine on grazes, then cover with gauze or a non-stick plaster
• Change the dressing daily or when wet or dirty. A wound kept slightly moist heals faster than one left to dry and crust

Do you need a tetanus shot?

Tetanus comes from bacteria in soil and rust entering through a wound. Childhood vaccination protects for about 10 years, and most Thai adults have not had a booster for far longer, so they often lack adequate immunity. The rule: for a clean, shallow wound, boost if your last dose was over 10 years ago; for dirty or deep wounds, soil-contaminated cuts or animal bites, boost if it was over 5 years ago. If you cannot remember your last dose, assume it is due.

The tetanus vaccine at the clinic is 350 baht/dose and can be given at the same visit as the dressing. Anyone who never completed a 3-dose primary course, or with a heavily contaminated wound, may also need tetanus immunoglobulin, which requires a hospital.

Signs that a wound is infected

Every wound is a little red around the edges and sore for the first 1–2 days, which is normal inflammation. Watch which way it goes: a normal wound improves every day, an infected one gets worse after day 2–3.

• Redness spreading more than 1–2 cm from the edge, or widening daily
• Swelling, warmth and pain increasing rather than easing
• Yellow-green pus, or cloudy, smelly discharge
• Fever, chills or feeling generally unwell
• A red streak running from the wound up the arm or leg, or tender swollen lymph nodes nearby
• A wound showing no sign of closing after 2 weeks

Good to know: Any one of these means see a doctor the same day. Early antibiotics stop it progressing to cellulitis or bloodstream infection. A spreading red streak or high fever with a wound should go to a hospital.

Wound care at the clinic

Mongkhondee Clinic cleans and dresses wounds, sutures small to medium wounds, gives tetanus boosters and follows wounds until healed. Dressing is charged by size from 100-250 baht including materials. See wound care and suture removal. Wounds beyond our scope, such as cuts down to tendon, uncontrolled bleeding, or large facial wounds needing a plastic surgeon, are referred to a suitable hospital straight away. When it is time for the stitches to come out, read stitch removal at the clinic, and for animal wounds, cat scratch or dog bite: do I need the rabies vaccine?.