Laceration Repair Explained
When a Cut Needs More Than a Bandage
What Counts as a Laceration?
A laceration is the medical term for a cut. It might come from a kitchen knife, a box cutter, shattered glass, a fall onto pavement, or a child tipping forward out of a stroller. Some are shallow. Some are deep. Some are straight and clean. Others are jagged and irregular. The skin is remarkably good at healing itself but only when the edges are close enough and the wound is clean.
Very small, superficial cuts can heal on their own. But deeper wounds that gape open, keep bleeding, expose fat, or sit on areas under tension often need help. If we simply leave those to “close naturally,” they may heal poorly, become infected, or leave a wider scar. Laceration repair is not about vanity. It is about infection prevention, function, and long term cosmetic outcome.
What Happens Before We Close It?
Before we ever place a stitch, we evaluate the wound carefully. How deep is it? Is there nerve, tendon, or vessel involvement? Can the patient move and feel normally beyond the cut? A deep laceration on the hand, for example, raises concern for tendon injury. Loss of sensation might signal nerve involvement. Those details matter more than the skin itself.
We then clean the wound thoroughly. This usually involves irrigation with sterile saline under pressure to flush out debris and bacteria. If there is concern for retained foreign material like glass or metal, we may obtain an X-ray to look for radio-opaque fragments (radio-opaque refers to materials that absorb or block X ray beams. On an X-ray image, those materials appear white or bright because the radiation cannot pass through them easily. Metal, many types of glass, and certain stones are radio-opaque. Organic materials like wood are often not, which is why deeper exploration or ultrasound may sometimes be needed if suspicion remains high). The area is then numbed with local anesthetic, most commonly lidocaine, so the repair can be done comfortably and precisely.
How Do Stitches Actually Work?
Sutures are medical grade threads used to bring wound edges together so the body can heal in alignment. They come in absorbable and non absorbable forms. Absorbable sutures dissolve over time and are often used in deeper layers or in certain areas like the inside of the mouth. Non absorbable sutures need to be removed after several days, depending on location.
On the face, we often prefer fine non absorbable sutures because they allow precise edge alignment and are removed early, which can improve cosmetic outcome. In deeper wounds, we may place layered closure, meaning absorbable sutures underneath and non absorbable sutures on the surface. The goal is simple. Reduce tension. Align the skin. Let biology do the rest.
When Do We Use Staples?
Yes, they are actual medical grade staples. They are fast, strong, and particularly useful in areas like the scalp where the skin is thick and under tension. The scalp also has hair coverage, which helps conceal small marks. In high tension areas like certain parts of the leg, staples can be more durable than sutures and quicker to place.
Cosmetically, staples and sutures often heal similarly on the scalp. On the face, we rarely use staples because precision matters more there. In surgical settings, staples are also commonly used to close abdominal incisions because they are efficient and secure. The choice is not random. It depends on location, tension, and cosmetic priorities.
What About Medical Glue?
Medical glue, typically a cyanoacrylate based adhesive, is ideal for small, straight, low tension cuts. It works best when the wound edges come together easily and there is no active bleeding. The glue forms a protective barrier and naturally flakes off over time as the skin heals underneath.
It is not appropriate for high tension areas, jagged wounds, or cuts that continue to ooze. Glue does not hold against movement or muscle pull the way sutures or staples do. But for the right wound, especially in children who would prefer not to see a needle, it can be an excellent option.
THE BOTTOM LINE
• Not every cut needs stitches, but deeper or gaping wounds often need help to heal well
• Proper cleaning, evaluation for deeper injury, and choosing the right closure method are just as important as the stitches themselves
• Sutures, staples, and medical glue each have specific roles based on location, tension, and cosmetic goals
Written by a Board-Certified Emergency Medicine Physician