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#143366 - 08/09/08 01:12 AM Re: Anyone used the Stapler? [Re: Nishnabotna]
rescueguru Offline
Wanderer
Member

Registered: 09/02/06
Posts: 119
Loc: Southeastern USA
I have assisted ED docs when wounds were closed with the stapler, but none without the Lidocaine local having been administered. I can't imagine attempting to staple or suture a wound without some form of anesthetic being given, OUCH!!, especially on a child. Any thoughts?
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#143369 - 08/09/08 01:31 AM Re: Anyone used the Stapler? [Re: rescueguru]
Jeff_M Offline
Addict

Registered: 07/18/07
Posts: 665
Loc: Northwest Florida
Originally Posted By: rescueguru
I have assisted ED docs when wounds were closed with the stapler, but none without the Lidocaine local having been administered. I can't imagine attempting to staple or suture a wound without some form of anesthetic being given, OUCH!!, especially on a child. Any thoughts?


One thought: You're right. It's likely to hurt like Hades. I was also wondering about it being for sale without an Rx.

I'm too lazy right now to do it right now, but any of our expert folks feel like writing a detailed post on exactly how to clean and dress various types of wounds "in the field," including using steri-strips for closure, if needed, for the benefit of the group, or maybe just dig up a good link?

Jeff

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#143380 - 08/09/08 02:59 AM Re: Anyone used the Stapler? [Re: climberslacker]
CANOEDOGS Offline
Pooh-Bah

Registered: 02/03/07
Posts: 1853
Loc: MINNESOTA

had one in my canoeing kit many years ago..had a real close
look at it one day and decided if i need something like that
i was in real trouble and saw it as a bad omen..so i left it home and use 4x4's and tape to close anything that nasty..
and Quickclot as a last resort..

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#143388 - 08/09/08 04:00 AM Re: Anyone used the Stapler? [Re: CANOEDOGS]
marduk Offline
Member

Registered: 01/25/04
Posts: 160
Loc: Mid-Missouri
I've used these in the ER and OR. It is easy to use, good closure BUT. This is wound closure, not recommended in the field. The wound needs to be meticulously cleaned first. It would hurt like Hades to use this without local anesthetic ( lidocaine). If you believe that girls like scars, you'll love this - prominent scar guaranteed each use. I keep some around to patch up pets and livestock, I use suture on the humans, usually after taking them to the ER, so I've got the stuff to do it right the first time. This would be good if you're way off the grid. or maybe combat situations, or if you really like scars.
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"Sometimes, it's better to be lucky than skillfull"


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#143429 - 08/09/08 06:46 PM Re: Anyone used the Stapler? [Re: marduk]
Fitzoid Offline
Enthusiast

Registered: 08/23/05
Posts: 289
Loc: WI, MA, and NYC
+1 on that.

Anyone using this in the field on a wound that hasn't been properly cleansed is risking a nasty infection and the misery that goes with it. Selling this to the general public? I wonder what kind of legal disclaimers it comes with...

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"When I read about the evils of drinking, I gave up reading." Henny Youngman

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#143430 - 08/09/08 07:05 PM Re: Anyone used the Stapler? [Re: marduk]
OldBaldGuy Offline
Geezer

Registered: 09/30/01
Posts: 5695
Loc: Former AFB in CA, recouping fr...
"...prominent scar guaranteed each use..."

Indeed they are. My stapled zippers are much neater looking than the sutured ones...
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OBG

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#143432 - 08/09/08 08:04 PM Re: Anyone used the Stapler? [Re: OldBaldGuy]
MDinana Offline
Pooh-Bah

Registered: 03/08/07
Posts: 2208
Loc: Beer&Cheese country
All right, someone asked for an official "how-to."

Scalp wounds in the ER don't usually get lidocaine. Why? Well, you use a needle to put in the lidocaine... so you're being stuck anyway. Just stick them with the staple and be done with it. Yeah, I hear it hurts. People tend to jump. Clean the wound copiously with clean water (some people use a little betadine swirled in, YMMV). Pull the edges together so that the parts match up (kind of like matching up puzzle pieces - the indent in the skin on one side matches to the extra skin on the other) Staple it closed. The middle of the stapler is the centerline for the staple.

For non-scalp wounds, we usually take tweezers, grab the skin, and actually evert it, so that when the staple is in place, the skin "falls" back into alighnment, with just a touch of the edge still rolled up (I hope this is making sense). Leaves less of a scar, and it's a 2-person job.

Probably OK to use in the field, provided: A) you irrigate the heck out of the wound, and there's no visible debris. At least 1/2 liter. More if it's bigger. B) You staple far apart, about 1cm between staples. This allows the skin to still be open between the stitches, allowing a route for pus and stuff to egress. Of course, you can also pull the staples and re=clean the wound if you really need to. But at that point, you can't re-staple it closed.

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#143436 - 08/09/08 08:47 PM Re: Anyone used the Stapler? [Re: MDinana]
nursemike Offline
Old Hand

Registered: 11/09/06
Posts: 870
Loc: wellington, fl
Originally Posted By: MDinana
All right, someone asked for an official "how-to."

Scalp wounds in the ER don't usually get lidocaine. Why? Well, you use a needle to put in the lidocaine... so you're being stuck anyway. Just stick them with the staple and be done with it. Yeah, I hear it hurts. People tend to jump. Clean the wound copiously with clean water (some people use a little betadine swirled in, YMMV). Pull the edges together so that the parts match up (kind of like matching up puzzle pieces - the indent in the skin on one side matches to the extra skin on the other) Staple it closed. The middle of the stapler is the centerline for the staple.

For non-scalp wounds, we usually take tweezers, grab the skin, and actually evert it, so that when the staple is in place, the skin "falls" back into alighnment, with just a touch of the edge still rolled up (I hope this is making sense). Leaves less of a scar, and it's a 2-person job.

Probably OK to use in the field, provided: A) you irrigate the heck out of the wound, and there's no visible debris. At least 1/2 liter. More if it's bigger. B) You staple far apart, about 1cm between staples. This allows the skin to still be open between the stitches, allowing a route for pus and stuff to egress. Of course, you can also pull the staples and re=clean the wound if you really need to. But at that point, you can't re-staple it closed.


Hockey players don't get lido, wherever the lac is-lidocaine burns on injection, and we occasionally use hypodermic needle bigger than the suture needle. or it may be that the scar tissue of previous wounds is numb anyway.
MDinana's guide reflects state of teh art practice as I have seen it-nice job, MD-
_________________________
Dance like you have never been hurt, work like no one is watching,love like you don't need the money.

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#143671 - 08/11/08 03:44 PM Re: Anyone used the Stapler? [Re: nursemike]
Susan Offline
Geezer

Registered: 01/21/04
Posts: 5163
Loc: W. WA
Why would anyone be so anxious to close a wound that they would buy one of these, much less use it?

Ignorance + a new toy = Darwin Award.

Don't you visualize your buddy considering this a new toy to play with? ("Okay, Joe, I've got the first twenty-five in. Need anything else stapled? Joe? Joe?")

I don't want people who watch doctor shows on TV and think they've learning something doing anything fancy on me.

Clean it, wrap it, go to a doctor. Period.

And that goes for my dog, too.

Sue

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