Stitches Close Skin. They Don’t Fix What’s Under It.
A hand laceration needs more than stitches whenever the cut has gone through skin into something that MOVES or FEELS — a tendon, a nerve, or an artery.
The wound can look small and still have done all three.
The depth of a hand cut is never judged by the length of the wound, because in the hand the important structures sit two to four millimetres below the surface.
Test function before you accept “it’s just a cut”.
The four-question check
Do these before the wound is closed, not after.
- Bend each joint separately. Hold the middle joint straight and bend only the tip. Then hold the base straight and bend the middle. A partially cut tendon can still move a finger — testing each joint in isolation is what exposes it
- Straighten fully. Loss of extension at one joint points at the extensor mechanism
- Light touch, both sides of the finger. Each finger has two nerves, one down each edge. Numbness along ONE side is a cut digital nerve, and it is easy to miss when the other side feels normal
- Bleeding pattern. Steady dark ooze is venous. Pulsatile bright red is arterial, and needs pressure and a hospital
A finger that still moves has not ruled out a tendon injury. It has only ruled out a complete one.
The cuts that are more serious than they look
Glass. The commonest cause of missed tendon and nerve injury in the hand. Glass is sharp enough to divide structures with almost no external wound, and fragments stay behind — glass shows on X-ray, so ask for one.
Anything over a knuckle sustained in a fight. That is a human bite until proven otherwise, and it goes in the emergency category regardless of size. See bites to the hand.
High-pressure injection injuries. Paint gun, grease gun, hydraulic line. A pinhole entry, minimal pain at first, catastrophic tissue loss within hours. This is a same-hour surgical emergency, not a wound to watch.
Palm cuts near the wrist crease. Everything crosses there — nine flexor tendons, the median nerve, both arteries.
The pattern in clinic is depressingly consistent: a small clean-looking cut, glued or stitched in a walk-in clinic, and six weeks later a finger that won’t bend. By then the tendon ends have retracted and scarred.
What to do in the first hour
- Direct pressure with a clean cloth, hand elevated above heart level
- No tourniquets, no rubber bands around fingers
- Rinse with clean running water; don’t scrub, don’t pour antiseptic into a deep wound
- Remove rings immediately — before swelling makes it a cutting-tool job
- Amputated part: wrap in damp gauze, seal in a plastic bag, place the bag on ice. Never directly on ice, never in water
- Check tetanus status
Who closes it, and when
Simple, clean, superficial cuts with normal movement and sensation: closure within 6 to 12 hours, primary care is fine.
Anything with a functional deficit: hand surgeon. Tendon and nerve repairs are best done within days, and the result degrades steadily after about three weeks as the ends retract.
Contaminated, bite, or crush wounds are often deliberately left open, washed out, and closed later. That is correct practice, not neglect.
Afterwards
- Week 0 to 2: wound healing, protective splinting if a structure was repaired
- Week 2: stitches out, scar management starts
- Week 2 to 6: motion restored under the protocol for whatever was repaired
- Month 3 to 12: if a nerve was repaired, sensation returns slowly — roughly a millimetre a day of regrowth
Cold intolerance and scar hypersensitivity are normal for months after a nerve injury and are the two things nobody warns people about.
The hand is dense. Everything important lives just under the surface — which is exactly why a small cut deserves a full examination rather than a quick glue.
Related reading
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.