Cut on lip, what wound care?

April 1, 2014 1:05 AM

Late night medical advice needed: my lovely cat nearly fell off the bed, and caught herself using my face. My lip, specifically. I've got a v shaped cut 4-5 mm long on one side and 2mm short side and it's somewhere around 2 - 3 mm deep. Clean and bandage? Go to emergency room? Regular doctor in the morning?

I've already tried urgent care, but the one urgent care facility in the area with late hours just changed their hours from 24 hours to closing at 11pm (discovered while IN the parking lot at 1:30am, yay.). Opted not to go to the emergency room expecting I'd be waiting until morning to be seen anyway since it's not that kind of a wound. Next stop was the pharmacist (I'm really sorry pharmacist dude, I am sure you hate these kinds of situations), who said to just clean it out and call the doctor in the morning. He said because it bled a lot, it probably cleaned itself out pretty good, so we should leave it if it closes or use a butterfly bandage.

So we got sterile saline and used a butterfly bandage. It's sort of closed, but I also see that the skin isn't completely matched up and there still is blood seeping periodically, which seems to be from occasionally moving my mouth (I'm trying hard not to do that). I'm not sure if I should just go to bed and call the doctor in the morning, or go to the emergency room. It doesn't seem THAT bad, but the interwebs are suggesting that that lip wounds are bad and often need stitches in a timely manner.

If this were on any other part of my body, I would have cleaned up and just bandaged, but it's not. It's started to swell (not that surprising, I guess) and hurts like a son of a bitch. The butterfly bandage doesn't appear have the cut edges lined up exactly right, but I'm afraid to take it off and pull apart the wound.

To complicate matters, I don't know if I have insurance or not (yay!). Had to use the health insurance exchange, signed up on March 15th, got info saying we weren't really signed up until we paid, which had to be done via old fashioned paper. Called the insurance company, who said as long as they got the payment by March 31st, insurance would start April 1st. Sent in the paperwork with bank information Monday of last week, and the money hasn't come out of checking. So a little gun shy of the emergency room. On the other hand, I don't really want a gaping hole in my lip. Oh, and my husband and I aren't working, because of a 2 year string of bad luck. So a bit scared about money.

Thoughts? Can I hold off until regular doctors hours resume, another 5-7 hours? This happened at almost exactly midnight and it's 3am here. It bled pretty significantly for about 20 minutes, seeped for another hour, and now only seems to be seeping when I make the mistake of moving my lips too much. The bottom of the wound has a "gap" about 1mm wide and 2mm long where the edged don't meet. It's filled with wet but not seeping blood so I can't see how deep and am a bit to afraid to fiddle with to clean out and see. Anything else I should be doing? Should I be reopening the lip to clean out, or just wait for a doctor to assess? And should I be going to urgent care first thing in the morning, or wait until my regular doctor can see me? Or is this less of a big deal than I think it is? I'm worried about both infection and a nasty looking scar. Yes, I always thought a facial scar would be badass, but now faced with it (no pun intended), I'm actually quite upset.

posted by [insert clever name here] to Health & Fitness (14 answers total)

Response by poster: stupid cat.
posted by [insert clever name here] at 1:05 AM on April 1, 2014 [3 favorites]

3 mm isn't very deep. if it's cleaned and disinfected, it should be fine. i'd go with what the pharmacist said.
posted by bruce at 1:20 AM on April 1, 2014

I vote ER. Sorry to say it, as I'm also largely unemployed and insuranceless, but lip and face wounds are both prone to scarring, and getting it taken care of sooner rather than later can help prevent that.

If this cut crosses the line from lip to skin--which I suspect, from your description, that it did--you definitely want to go, as that's an area that often heals unevenly on its own--you'll have a sudden jog in your lipline where the two sides of the cut sealed up a millimeter or two off of where the natural line is, which I found out the hard way when I had a cat scratch me there as a teen. Over time it's become less noticeable, but even fifteen years later, I still have a jog in my upper lip that I'm self conscious about. (Does anyone else notice? Probably not. Am I hyperaware of it anyhow? Totally.)

The fact that it's been three hours and you're still seeping blood also seems not great to me. You can fight with the insurance company later, or you can appeal to the hospital for charity care, but I'd at least go and have someone look at this and get it properly cleaned out.
posted by MeghanC at 1:39 AM on April 1, 2014 [2 favorites]

You'll probably have a scar but its not an emergency. Keep it clean and go to the dr or urgent care in the morning if it hasn't closed up
posted by missmagenta at 1:52 AM on April 1, 2014 [1 favorite]

Our kid hit her chin badly and we went to the ER and wound up choosing a plastic surgeon to do the repair over the ER guy doing glue/stitches because the consensus seems to be that for facial wounds that risk a scar, you want to minimize. Also cats are as filthy as humans when it comes to infections, and cleaning it out makes a difference. You may need antibiotics.

We took the kid in at about 9pm, and then ended up waiting about 12-15 hours for the actual surgery, so you have time. They just cleaned the wound first. No-one seemed rushed about fixing it, and her bleeding stopped quite quickly although it was deeper than yours.

A scar on your lip and mouth area can be really visible and disconcerting. Your eyes, nose and mouth are what 90% of people looking at you will see first, and while I'm sure you will rock your cool scar (I have several facial scars I'm fine with now) - why put yourself through that?

We had subsidized care so it didn't cost us much to fix. Had it cost a lot, I would have been fine getting an ER doctor to do the stitches if it was that vs a butterfly bandage. We had follow-up visits to check on the wound and the option of a pricey cream to minimize scarring that the nurse said we could skip if we wanted to just massage moisturizer on regularly.
posted by viggorlijah at 2:33 AM on April 1, 2014

Please go to the doctor this morning, if not for aesthetics then for antibiotics to stave off infection.
posted by Sweetie Darling at 4:52 AM on April 1, 2014 [1 favorite]

Same thing happened to me, but she got me right across the nose (jumped off a bookcase onto the bed where I was sleeping and caught herself on my face). I did not get it treated and I have a scar. If I could do it over, I would get it treated.
posted by valeries at 5:16 AM on April 1, 2014

When this happened to me (albeit, cat got my eyelid), I went to the ER. Here's what happened: They treated it as high priority, but not super emergency. I got a bunch of "was this actually your SO abusing you" type of questions. Then they cleaned it with saline, applied topical lidocaine to numb the area, and stitched my eyelid. They didn't give me antibiotics because cat scratches are not full of bacteria like cat bites.

This is important: If I hadn't been up-to-date on my tetanus booster, they would have given me one. So if you aren't, get one.

My advice: ER. My wound (luckily) missed damaging anything important and my cat just got the fatty tissue in the eyelid. It was painful as @#$! though and I couldn't sleep because of the stinging. The stitches were really important for fast healing and minimizing the chance of infection. My wound didn't quite match up (she took out a thin layer of tissue with her claw) and the stitches held everything together so it could heal.

If not having a scar is important to you, def ER. The stitches helped the area heal, plus I applied antibiotic ointment twice daily to keep the area moist; the ER doc said getting dried out promotes scarring. For comparison, the same swipe of claws got me across the nose, but very shallow and it didn't keep bleeding. The eyelid wound healed quickly and any trace of the wound was gone in three weeks. The nose scratch, which scabbed slightly, took several months before a trace of the wound was gone.
posted by DoubleLune at 5:46 AM on April 1, 2014

Whatever you do, I vote seeing some sort of doc. I got scratched by my cat on my leg. I ended up with a bloodstream infection and a septic joint requiring surgery. I was in the hospital for a week total because I got so sick. Cat scratches aren't anything to fool with, especially on your face. Hope you're OK now.
posted by kathrynm at 9:29 AM on April 1, 2014 [1 favorite]

Cat scratches are not clean by any measure, but the parts of your body that heal the fastest and resist infection are the ones with high blood-flow. This is why you can get cuts near your anus and, despite the flow of bacteria-ridden feces nearby, those can heal. Your face and mouth are other such places, because of all the things you put in your mouth, and the bacteria that live there. (And other reasons, no doubt-- this is also why minor face lacerations appear to bleed like madness.)

I agree with the above that the scar is a possibility, and ER is the way to go with that. If you can live with a scar and don't want the expense, clean it out (I'm not sure what's recommended these days-- alcohol/iodine/hydrogen peroxide/antibiotic cream) and tape it shut. Your non-immune-compromised body will do its thing. Expect to accidentally rip it open a few times now and then; you might want to carry a small kit for when this happens, including a resumption of some bleeding.
posted by Sunburnt at 10:21 AM on April 1, 2014

This is your face. I hope you have already had it seen to.
posted by St. Alia of the Bunnies at 4:45 PM on April 1, 2014

IANYEMP (Not Your Emergency Medicine Physician) but I can tell you a few general things about lip lacerations.

1. For most lacerations that need to be closed with sutures or glue, waiting until you can schedule a doctor's appointment is not a good idea. The longer you leave a wound open, the more likely it is to be dirty/starting to heal over. Depending on the circumstances, I won't close most wounds if it's been longer than 12-24 hours since it happened.
2. Lip lacerations that cross the vermilion border (that's the border between the pink part of your lip and the rest of your skin) are trickier to repair than your average laceration, because the alignment on the border needs to be carefully done. Even 1mm of misalignment can be noticeable.

- Pharmacists don't close wounds, that is not their expertise, so I wouldn't give a lot of weight to that assessment - no offense to pharmacists, they are great for questions about medications.
- Primary care doctors aren't always very excited about doing procedures like laceration repairs. For any significant wound or wound in a sensitive location I suggest not going to primary care unless you know your doctor likes to do that sort of thing and does it regularly.
- Emergency medicine physicians, PAs, NPs etc can close almost any wound, including facial wounds, without a problem. If the wound is complex and large, we may call in a specialist because we can't be stuck in a single room for that long. If you go to an academic center where a plastic surgery service is available, it always makes me grin a little bit when people request the plastic surgery service repair their lac, because the person who is first call for plastics is often an intern or resident (sometimes even a rotating emergency medicine resident).
posted by treehorn+bunny at 5:53 PM on April 1, 2014

Totally depends on your personal comfort level in terms of advanced wound care and facial scarring. If you trust yourself to keep the cut really meticulously nice and clean and not to let it get infected, and you're OK with the possibility of having a scar on your lip, I don't think you'd be crazy at all to take care of it yourself. That's what I'd do, but then I was raised by a doctor and a nurse and have had wilderness medical training up to the EMT level, and think that a few scars here and there add some much-needed character to a face.

I also don't think you'd be crazy at all to get it stitched up or otherwise professionally doctored, if that would make you more comfortable. If I remember correctly, the time limit on stitches for facial wounds is about twelve hours after the injury though, so it may no longer be an option. After a while the tissue has healed too much for stitches. (It may still be weeping blood or plasma, but nevertheless the healing process is too advanced.) I could totally be wrong about that though, and if you're concerned at all about scarring or infection then a doctor can definitely give you the best care even if stitches are no longer an option.

It's totally your call. If you're going to deal with it on your own, make sure you are cleaning it well every few hours. Ideally you want to be using a weak solution of povidone iodine in saline or sterile water. You want to keep it dry the rest of the time, and avoid moving things around more than you have to. It will swell; cut lips always do that, it doesn't mean it's infected. If it continues to hurt a lot, or if it gets hot, or starts to weep pus then definitely get yourself to a doctor because the wound has gotten out of control and it's time to call in the pros.

You can totally do this at home though; as a little boy I messed my lip up bad several times with all manner of filthy, germ-ridden things (gravel, little league baseballs, the heads of other little boys) and my mom always just patched me up. I'd cry about it (mostly out of fear rather than pain because a split lip bleeds like crazy, especially that one time when I fell off my bike and just rubbed my whole face against the asphalt) and go around with a comically fat lip for a couple of days, and then I'd be fine. No scars. My mom was a nurse though, so she knew what she was doing. Still, if I'd gone to the hospital every time I got a big dirty cut on my face it would've been a damned inconvenience, I'm sure.
posted by Scientist at 7:13 PM on April 1, 2014

Response by poster: Follow up for anyone who finds this further down the line - I did not go to the emergency room, but saw the doctor the next day. My insurance did kick in, my husband confirmed that day. We just didn't have the card yet and the company was swamped processing payments thanks to the last days to register at healthcare.gov so had not taken the first month's premium out.

The stress of it all gave me a horrible vomiting migraine, so we didn't go to the doctor until the afternoon. At which point it was too late for stitches, but they cleaned it up a bit and sent me home with antibiotics for 10 days. It didn't cross the border of the lip, it was a few mm away. I had to where a butterfly bandage for a couple days, and big smiles/laughter would still cause it to seep a bit.

It's now mostly unnoticeable except a small bump where the two pieces didn't meet up. I assume it's scar tissue. But it's the underside of my lip, so it's in shadow, not really noticeable (I'm more at risk of bitting it than other people seeing it). And within a day I realized I didn't care if it scarredd, but I think being amped up on adrenaline from the surprise attack and the blood EVERYWHERE, I found something to obsess over, and scarring was the thing.

If I could have done it again, I probably would have gone to the ER, but honestly, after getting to the previously 24 hour urgent care and finding them closed, I was sort of defeated. Between that and the fear of lack of insurance, it was just too much to deal with.

As a final note to the story, the cat responsible, who's generally been very aloof since adopting her 2 years ago has now decided she's my best bud. I guess she required a blood sacrifice. I'd argue she feels bad, but she's a cat.
posted by [insert clever name here] at 8:40 AM on April 20, 2014 [2 favorites]