Closing wounds improperly can lead to severe infections.

I agree 100%. Don't do it!

I'm not an expert, but I assume that the introduction of any non-sterile material into a deep wound is an extremely bad idea.

...no trained paramedic/emergency rooms available within a reasonable amount of time and needing to close a serious wound.

FYI I've attended medic first aid training (Scuba rescue diver cert), us army general first aid, worked in a hospital (5 blocks from WTC during 9-11), ...

I apologize in advance for the long and probably confusing reply but I tend to ramble on. I hope some of the information is helpful to people.

As a surgical assistant I routinely help close surgical wounds with suture, staples, steri-strips and skin glue. From working closely with surgeons I have an understanding of wound healing issues such as infection and scarring. I also have several years of experience as an EMT I/II and W-EMT.

Closure of a wound is considered to be identifying and attaching together the wound edges for the full thickness and length of the wound.

Packing and dressing (bandaging and dressing) a wound is considered to be using things like gauze sponges (the packing/bandage) in/on the wound and covering them with something like tape or self adhesive wrap (the dressing)

Some things to consider about closing a wound in the field:

Is the wound more than skin deep, is there a possibility that underlying structures such as nerves, blood vessels, tendons etc. involved? Is the bleeding uncontrolled? If any of these are the case, wound closure in the field is a waste of time and could hinder proper medical treatment. Temporary or partial closure, or packing and dressing the wound and transporting the patient to higher medical care might be more appropriate. Deep wounds, i.e. more than full skin thickness should not, and probably can not, be closed in the field.

If the wound is not deep with nothing that requires repair and no uncontrolled bleeding, is the would clean? Was the injury caused by an uncontaminated object to a clean area? If not, do you have the resources to thoroughly clean the wound with lots of water, preferably sterile, and disinfectant? Closing a dirty wound will significantly increase the risk of infection.

If the injury is superficial but more than a simple scrape or nick and field closure is appropriate then what is the goal off the field wound closure? Better wound healing, limiting annoying but trivial bleeding and reducing the risk of infection. Tools that might be used are things like suture, staples, steri-strips and skin glue.

Suture: Requires a cooperative patient, technical proficiency, instruments (needle driver, forceps, scissors), suture (e.g. 3-0/5-0 mono-filament, nonabsorbable), preferably a local anesthetic (e.g. Lidocaine) and a very clean work area. Suture is slow to apply but generally easy to remove and provides good closure to any wound location.

Staples: Requires a skin stapler (and typically a forceps) and a cooperative patient. Staples are relatively quick but not painless and work almost anywhere on the body, but are not typically used on the hands or face. Staples are generally easy to remove and provide a good closure. An additional dressing is typically used.

Steri-strips/butter fly closures: Quick, easy to apply, can be used almost anywhere on the body, and are often used with benzoin or mastisol to aid adhesion. Steri-strips are usually covered with a dressing. Steri-strips can be very difficult and painful to remove. This is particularly important to consider if the closure is only being considered as a temporary measure.

Skin Glue: Medical grade cyanoacrylate (e.g. Dermabond, Indermil) This is a quick, relatively safe and easy to use method of sticking skin edges together. Its likely everyone on the board here has a crazy glue story. This is my preferred method of wound closure at home and in the field. It works anywhere on the body, is easy to use and doesn't require additional dressing.

Depending on the wound, apply bacitracin/neosporin, sometimes silvadene (usually burns though), or just leave the top dry.

So generally, whats the best way to pack a wound and keep it as clean as possible until you can get proper treatment? I always thought it was sterile irrigation and then (sterile) 4X4's?