When our children are born, our first instinct is to protect them and shield them from harm. We place them on their backs to sleep. We scour the house for choke hazards. We fill the electrical sockets with protective outlet covers. We install baby gates to make any area of the house not baby-proofed inaccessible. In essence, we do everything humanly possible to keep our kids safe. But, try as we might, there are always going to be booboos along the way – especially when our little munchkins start to walk. There will be bumps and scrapes, cuts and bruises, a few goose eggs and miscellaneous abrasions. Unfortunately, it’s all a part of growing up. So how do we know when an injury that breaks the skin will potentially result in a visible scar? How do we decide what is deserving of stitches? And, is there anything we can do to help prevent or lessen the degree of permanent scarring?
Skin, the body’s largest organ, serves as a protectant and barrier to the environment. When there’s a break in the skin, the body sees it as a potential opportunity for bacteria and infection to get in, so its primary job is to seal the break. The point is to seal the area as quickly as possible, by producing skin collagen that is thicker than normal skin. Over time, some of that thicker collagen, designed to close up the break gets reabsorbed by the body when the risk of infection is gone, will be replaced and replenished by more natural skin collagen. But there will always be at least a little bit of that “quick to the rescue” scar collagen on the wound site, better known as a scar.
The time for the decision for whether stitches are needed is when the injury has just happened. So how do you determine whether to stitch or not to stitch? A wide, gaping abrasion likely warrants an emergency room visit and stitches. The wider the area of the wound, the more quick-and-ugly collagen the body will need to deposit. Stitches will help decrease the area that needs to be sealed by collagen, often reducing the size and amount of scar tissue.
Well-Being spoke to Dr. Michael R. Nichols, DMD, MD, of Oral and Facial Surgery of Mississippi, who is a licensed dentist and physician who practices a full range of oral, maxillofacial and cosmetic reconstructive surgery specifically for the face and neck.
According to Dr. Nichols, the injury may need stitches if it is irregular or it tends to gape open (if the margins of the injury do not touch without traction). Stitches also may be indicated if bleeding does not stop after some time or if the cut appears to be the full thickness of the skin.
KidsHealth.org offers the following scenarios where medical attention and even a few stitches may be warranted if the injury…
If a cut continues to bleed, you should seek medical attention. The wound should be treated and stitched immediately so that its edges can come together and heal properly.
Dr. Nichols notes, “Wound care is one of the key things in management of an injury. The wound needs to be kept clean and free of any scabbing with some type of barrier such as Aquaphor, Neosporin or other type of wound dressing.”
Few kids make it through childhood without scars of some kind. Let’s face it, some of those collagen reminders of scraped knees and elbows are not only rites of passage, but badges of honor. But when the injuries are to the face, we generally take a more serious approach to wound care and scar prevention.
“The more prominent areas of the face have more of a tendency to be traumatized easily, such as the nose, the chin, and the forehead,” explains Dr. Nichols. “Other areas of the face can also be injured with the potential of scarring, depending on the nature of the accident.”
“There are some topical applications on the market that are indicated to improve the appearance of scars” adds Nichols. “Some of these are compounded at pharmacies and yield good results. But nothing replaces appropriate approximation of wound edges.”
Mederma is one commonly used anti-scar cream. It is recommended by 72 percent of pharmacists according to U.S. News’ Top Recommended Health Products. The silicone in Mederma and other products helps reduce excess collagen formation.
When anti-scar topicals are not enough to reduce the appearance of scars, there are other options for consideration. According to Dr. Nichols, the extent of corrective treatment of a scar is often dependent on the way the child feels about his or her appearance.
“Occasionally scars have to be evaluated for other non-surgical treatments such as steroid injections, collagen based fillers and/or fat grafting,” Dr. Nichols adds. “We have a CO2 Fractional laser that has the ability to specifically treat and reduce scarring. It is ideal for the removal of the thickest and most complex lesions and scars, leaving the patient with a less visible and more acceptable scar.”
We can’t protect our progeny from every booboo and bungle, but we can be prepared when it happens. Knowing how to approach an injury that involves a gaping cut or abrasion, is half the battle, when a booboo needs more than a kiss to make it better.
Michael R. Nichols, DMD, M.D., received his Bachelor of Science degree from the University of Southern Mississippi, followed by a Doctor of Medical Dentistry degree from the University of Mississippi. He obtained his Medical degree from the University of Alabama, and after completing a general surgery internship, continued his studies in Maxillofacial Surgery at the University of Alabama. In addition to his private practice, Dr. Nichols holds an appointment as an Associate Professor at the University Of Mississippi Department Of Oral Maxillofacial Surgery. He is Board Certified by the American Board of Oral and Maxillofacial Surgery.