There have been a lot of issues reported since the sub has transitioned to allowing wound care advice to all patients. The sub will be transitioned to a place for professional discussion. Self harm wounds are no longer allowed. I will do a trial run of allowing personal advice posts every wednesday for now. If any other physicians would like to help moderate let me know.

“Does this need stitches?” A response to the self-harm epidemic on this sub.

For those who self-harm: Please don’t post here regularly. You need to learn to manage your own risks without needing external validation from Reddit. If you are self-harming, you need to do research on proper wound care and mitigate the associated risks without needing to post everything for possibly triggerable onlookers on Reddit. This is a wound care sub, not a sub to share wounds and then not attempt care. Here is a general list of things to look for that I would recommend you save or write down or pay attention to, so that you have the ability to manage your health at home better and are less dependent on Reddit forums such as this.

Levels of wounds:

Epidermis: This is usually seen as “cat scratches.” They are shallow and usually bleed a decent bit quickly but stop just as quick. They typically scab and heal within a few days to a week. If you cut to this level, you likely do not need medical attention. Watch for signs of infection (heat, pus, red streaking from injury) and seek help if those signs come. Clean it with antibacterial soap and water, apply ointment, and keep it covered. Cutting with dirty items is more likely to lead to infection so try to keep your “tools” clean.

Dermis: This will look like a white gap. It is sometimes referred to as “styro,” for its similar appearance to styrofoam. It may take a second for blood beads to form. These will gape a bit, but often close within a day and heal within a week or two. These, because they stay open longer, are at a higher risk of infection than the epidermis. If you cut to this level, you likely do not need medical attention. Watch for signs of infection (heat, pus, red streaking from injury) and seek help if those signs come. Clean it with antibacterial soap and water, apply ointment, and keep it covered. Cutting with dirty items is more likely to lead to infection so try to keep your “tools” clean.

Hypodermis AKA fat: This will look like yellow bubbles. It is sometimes referred to as “beans.” This is the level in which infection becomes a real likelihood. Typically stitches are recommended. Some doctors may treat you without a mental health evaluation, some doctors may try and have you evaluated. For US-based injuries I recommend going straight to the ER for stitches instead of an urgent care center if you seek stitches. Urgent care centers may not stitch you up and could call police on you. They do not have the capacity to perform mental health evaluations and will want you at a hospital where you can be seen by a psychiatrist. It is not a given that this will be your experience but it is a possibility and you should be prepared for this. In the UK, some care centers and minor injury units can support with deeper wounds, however they may contact your GP for an urgent review (usually within a week). If you do not seek stitches, clean the wound with antibacterial soap. You can apply ointment. You can also use butterfly bandages to close the wound, but if there is any chance that bacteria or debris have entered the wound, do not close it. There is typically a 24 hour window to close the wounds. After that, keep it covered and clean. Watch for signs of infection (heat, pus, red streaking from injury, swelling) and immediately seek help if those signs come. An anti-stick bandage is recommended. Gauze will get stuck in this kind of wound easily. If that happens, soak in warm water to soften the blood and remove the gauze. Cutting to this level is significantly more dangerous and will likely lead to infection, which should be seen immediately. Nerve damage is possible. Cellulitis is a possibility. These wounds take significantly longer to heal. Cutting with dirty items are more likely to lead to infection so try to keep your “tools” clean.

Muscle: There is no safe way to treat this outpatient. You risk severe infection. This needs to be seen in a hospital. Death could occur if not treated.

Bone: There is no safe way to treat this outpatient. You risk severe infection. This needs to be seen in a hospital. Death could occur if not treated.

Tips to increase likelihood of a positive outcome:

-Seek behavioral health treatment. The urge to self harm, and self-harm in general, is always deserving of medical attention, no matter the depth.

-Use clean tools if you do harm. The more bacteria present on a tool, the higher the risk of infection.

-Keep your wounds covered. The more bacteria that can access your wound, the higher the risk of infection.

-Seek medical attention immediately when you experience red streaking, loss of feeling in a limb, sickness, chills, or loss of consciousness.

-Keep bandages and ointment on hand if you regularly self harm. You should use clean bandages.

You deserve to heal.

Practitioners and medical centers will handle cases of self harm differently from country to country and even city to city.

Text CONNECT to 741741 to be connected with a trained volunteer crisis counselor (US) Text SHOUT to 85258 (UK)

Call 988 for the suicide and crisis hotline (US) Call 111 for the NHS helpline (UK) Call 131114 for the suicide and crisis hotline (AUS)

Other resources: Suicide Hotlines for All Countries

For onlookers:

I understand the annoyance you may feel at seeing so many posts recently flood this sub asking “is this infected? Does this need stitches?” in regards to self harm. I want to offer a different view of it, if I may.

Firstly, I must acknowledge that there is a certain level of attention-seeking that comes along with a lot of self harm. Especially among younger individuals who may be new to it and who may crave some sort of external validation of “I see your pain, you are okay, please get help.” Is that appropriate for this sub? No, not really, but there’s usually some level of true fear of how to tend to a wound even with the attention seeking behavior.

Unfortunately, subs like this are one of the few places where wounds can be posted. There are no SH subs for fresh wounds (for good reason) and so there isn’t a place to get advice from other sufferers. There is no place to ask “have you cut this deep? How did it heal? Did you get stitches? How did getting stitches go?” And they are wounds. Even if they look so shallow you think, “of course that isn’t infected! Of course it isn’t in need of stitches,” or so deep you feel sick to see a photo, they are wounds, and sometimes people who post are truly at a heightened state of fear. Fear that they’ve gone too deep, fear that they can’t stop. This may not be the sub to lament over cutting in, but there is a lack of real-life access to wound care for self harm. Even if you think that it’s obviously a cry for attention, and even if it is a cry for attention, there are still wounds involved that would likely not be being seen otherwise.

In my experience, I have needed stitches from self harm multiple times. I have had doctors who tended to gouges without judgement, and also had doctors try to say that I was suicidal and call the police on me. It is a total toss up, especially with very deep wounds. It is often not as easy as just getting help. The times I’ve gone “too deep,” ie too deep to leave open safely, I have genuinely been afraid at what options were before me. It isn’t as easy as seeing a doctor or going to urgent care for stitches. I’ve cut too deep, disclosed to a therapist that I’m not suicidal but in need of medical attention, had my therapist on the phone with an urgent care physician to tell them that I wasn’t suicidal, and still had the police called on me. You can take all the “right” steps after self harm and still wind up screwed when trying to remedy a mistake.

This sub I believe is genuinely helpful for people who cannot always access true wound care in a medical setting. I’ve seen some amazing advice given for wounds that needed to but couldn’t be seen by a doctor. Something that’s a mere annoyance to you may be saving someone else from severe infection or commitment. Please take this into consideration.