Vivid Ready

Most wounds should not be closed, and the ones that should can usually be done with strips or glue rather than stitches. If nobody is coming, delayed closure at 48 hours is the safe procedure and it is a real technique, not a compromise.

Closing a wound feels like fixing it. It is the instinct everybody has and it is wrong more often than it is right.

This page teaches the decision, which is the part that actually matters, and then gives you the last-resort procedure, because in a household with nobody coming, "go to A&E" is not an answer.

Read clean and dress a wound first. Irrigation decides the outcome far more than closure does.

The default is open

Closing a wound traps whatever is inside it.

An open wound that is irrigated, dressed and kept clean heals from the base upward. It takes longer, it leaves a wider scar, and it is very unlikely to kill anybody.

A closed wound with contamination sealed inside becomes an abscess: a pocket of infection under a sealed surface, with nowhere to drain, which is the direct route to the sepsis page.

In a setting with no antibiotics and no surgeon, that asymmetry gets much sharper. A wide scar is a cosmetic problem. A deep abscess is a life-threatening one.

So: the default is open. Closure is the exception, for clean, fresh, low-tension wounds with straight edges.

Wounds that must never be closed

DANGER

Leave these open, always, however tempting and however neat they look:

Any bite. Animal or human. Bites are punctures loaded with bacteria, and closing them reliably produces infection. WHO guidance is explicitly to postpone suturing of bite wounds. Human bites are among the dirtiest wounds there are, including the knuckle injury from a punch to a mouth.
Puncture wounds. Nails, forks, needles, thorns. The entry is small and the contamination is deep. Nothing you can do reaches the bottom.
Heavily contaminated wounds: soil, manure, rust, road grit, anything agricultural.
Crush injuries, and wounds with dead or ragged tissue.
Any wound already showing signs of infection: redness, heat, swelling, pus, increasing pain.
Wounds with anything still in them that you could not remove.
Deep wounds you cannot see the bottom of.
Abscesses. These need to drain, not to be sealed.

The rule of thumb: if it is dirty, deep, or a puncture, it stays open.

The six hour rule is largely a myth

Worth correcting, because it drives bad decisions in both directions.

The traditional teaching is a six-hour "golden period" after which a wound cannot be closed. The evidence does not support it well: studies find similar infection rates in wounds closed before and after six hours, and clean lacerations are routinely closed up to 18 hours on the body and 24 hours on the face.

What this means practically:

Do not rush to close a wound because a clock is running. Time spent irrigating properly is better spent than time saved.
Do not refuse to consider closure just because hours have passed. A clean, well-irrigated wound at eight hours is a better candidate than a dirty one at two.
Cleanliness and mechanism matter far more than elapsed time. How dirty it is, and how it happened, are the real questions.

What you can close, and with what

Suitable for closure at home:

Clean, fresh, straight-edged.
Low tension: the edges sit together on their own without being pulled.
Not over a joint or anywhere that moves and stretches.
Not on hairy or oily skin, where nothing adhesive will hold.
Not gaping.

Methods, best first

Method	Good for	Not for
Adhesive strips (steri-strips, butterfly)	Straight, low-tension cuts. Cheap, safe, no skill needed	Joints, hairy or oily skin, lax skin, gaping wounds, wriggling toddlers
Skin glue (cyanoacrylate)	Short, clean, low-tension cuts, especially on the face	Anywhere near the eyes. Joints. Hairy areas. Inside the wound
Sutures	Deep, gaping, high-tension wounds	A household without training

Applying strips properly:

Irrigate thoroughly first. Dry the surrounding skin completely; they will not stick to wet skin.
Start in the middle. Fix one side, pull the edges gently together, lay it across, fix the other side.
Work outward, alternating sides.
Leave gaps between strips. The wound must still be able to drain. Sealing it completely is the error.
Leave 5 to 10 days, and remove sooner if there is any sign of infection.

Skin glue: hold the edges together, run a thin line along the surface of the closed edges, and hold for a minute. Never put glue inside the wound, where it acts as a foreign body and prevents healing. Ordinary superglue is chemically similar but is not sterile and is more irritant to tissue; it is a genuine last resort rather than an equivalent.

Delayed primary closure, the honest answer

This is the technique that answers "what if nobody is coming", and it is not a compromise. It is standard practice for contaminated wounds.

Why it works: the wound gets to declare itself. Contamination that was going to cause an infection does so in the first 48 hours, while the wound is open and can drain. What is left after two clean days is a wound safe to close.

Why this is the right technique for a household with no help: it removes the judgement call you are least equipped to make. Instead of deciding on day one whether a wound is clean enough to close, you wait and let it show you. Studies of contaminated wounds managed this way find very low infection rates.

If you take one thing from this page: when in doubt, irrigate, leave it open, and look again in two days.

Packing a wound that stays open

A deep open wound needs the base kept open so it heals from the bottom rather than sealing over a cavity.

Pack lightly with clean damp gauze, or the cleanest cloth you have, boiled and dried.
Damp, not soaking. Sterile saline or clean boiled water.
Do not ram it in. Firm packing damages tissue and impedes blood supply. It should fill the space, not stretch it.
Change daily, or more often if it soaks through.
Leave a tail outside and count what goes in. Retained packing is a genuine and easily avoided disaster.
Cover with a dressing.

The wound closes gradually from the base. Reduce the packing as the cavity shrinks.

If you are going to improvise stitches anyway

DANGER

This app does not teach suturing technique, and the reason is not squeamishness. Suturing is a hands-on skill: needle angle, bite depth, tension, spacing and knot security all have to be felt. Done badly it produces a wound that is worse than one left open, because it is sealed under tension with dead tissue inside.

If you have genuinely reached a point where you are considering it, the correct decision in almost every case is delayed primary closure instead. It is safer, it needs no skill, and the outcome is nearly always better.

If you are going to do it regardless, three things reduce the harm:

Never close a dirty wound, a bite, or a puncture. No exception. This is the one that kills.

Never close it tightly, and never close it completely. Leave a gap for drainage. Loose approximation, not a watertight seal.

Stop and open it if anything changes. Increasing pain after 24 to 48 hours, spreading redness, heat, swelling or discharge means remove the closure immediately and let it drain. A sealed infection is worse than the open wound you started with.

If you want this capability properly, learn it properly and in advance, from someone who can watch you do it. That is a real thing to arrange while there is time, and it is not something to read about at 3am with somebody bleeding.

And the thing that actually prevents all of this: thorough irrigation, early, on every wound however trivial. Five to ten minutes of running water on a cut today is worth more than any amount of skill applied to an infected wound next week.