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#209350 - 10/08/10 10:12 PM Re: Recommended Home/Car suture wound closure kit [Re: dougwalkabout]
hikermor Offline
Geezer in Chief
Geezer

Registered: 08/26/06
Posts: 7705
Loc: southern Cal
Originally Posted By: dougwalkabout

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.


Depends on your objective. It is a great way to increase medical costs, and possibly, even, support the funeral industry.

I have dressed a fair number of wounds in back country settings, and I have never had to suture anything. Zero. Zilch. Nada.
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#209352 - 10/08/10 10:26 PM Re: Recommended Home/Car suture wound closure kit [Re: Cockroach]
ironraven Offline
Cranky Geek
Carpal Tunnel

Registered: 09/08/05
Posts: 4642
Loc: Vermont
Stitching looks really good, but honestly, listen to Pete.

I've had stitches several times. The bleeding had pretty much stopped in most of those. The stitches are mostly to help you heal faster and with fewer long term complications (which includes reopening). I can not think of a situation were I would require stitches where most of us would be functional enough long enough for it to matter.

I'm not a fan of tourniquets, and I like t-quits more than I like stitches. The only things I can think of where I couldn't pack it with celox and gauze then secure with vet wrap and duct tape are massive abodominal injuries, internal injuries, or amputation. In the first, unless you can get evac'ed, you're dead. Internals... again, evac. Amputation, if you can't get it stopped with pressure, then you'll bleed out. All of this assumes shock doesn't get you.

Everything else, you either self evacuate, go into survival mode while your buddies get help, or you try to stay alive, get your signals out and hope that your contact person gets the cavalry rolling. If you want somethign for home/car, unless you are homesteading way back in the boonies, you aren't going to need to stitch. You need to control the bleeding and transport. Period.

If "home and car" also corrisponds with "there is no doctor for hours if not days" you are either very well off the beaten track (in which case, get training, and you'll learn where to look for suture kits- it isn't hard to find), in less than wonderful place to live, or we are talking TEOTWAWKI, in which case, I'd rather bleed out than die from blood poisoning honestly.
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#209353 - 10/08/10 10:36 PM Re: Recommended Home/Car suture wound closure kit [Re: Cockroach]
haertig Offline
Pooh-Bah

Registered: 03/13/05
Posts: 2322
Loc: Colorado
Originally Posted By: Cockroach
...no trained paramedic/emergency rooms available within a reasonable amount of time and needing to close a serious wound.

You are making a bad assumption here. "...needing to close a serious wound". You don't need to do that. And you should not. But you appear intent on your planned course of action. Just do not expect good results. Be prepared for bad, possibly very very bad results instead.

Quote:
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), ...

No offense intended, but none of these even remotely qualify as training for wound care at the level you are contemplating.

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#209354 - 10/08/10 10:39 PM Re: Recommended Home/Car suture wound closure kit [Re: Cockroach]
Jeff_M Offline
Addict

Registered: 07/18/07
Posts: 665
Loc: Northwest Florida
The primary objectives of wound treatment are hemostasis(control of bleeding) and prevention of infection. It is difficult to imagine a scenario, even in a post-disaster or wilderness setting, where suturing would be necessary or advisable, especially without the relevant special training, experience or clinical judgment. Many times, suturing is done for essentially cosmetic reasons. Done inappropriately, it can make a bad situation far worse. Potential complications include infection, nerve damage, loss of function, more severe scarring, sepsis, emboli, or massive tissue loss, amputation and even death.

But, in some situations, having the necessary supplies and equipment on hand, just in case one happens to come across someone who has the skills but not the gear, might be beneficial.

After copious irrigation, most wound margins can be suitably and temporarily approximated or closed with steri-strips and tincture of benzoin. In the field, a baggie filled with clean water, into which some betadine or a couple of betadine swabs have been added, punctured in one corner with a pin, allows suitable pressure irrigation by squeezing the bag.

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#209355 - 10/09/10 12:22 AM Re: Recommended Home/Car suture wound closure kit [Re: njs]
Cockroach Offline
Stranger

Registered: 09/18/10
Posts: 13
Originally Posted By: njs
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.


Execllent! Very nice summary of various wound treatments, thank you.
I have used CA glue (cyanacrylate) for first aid a thumb wound that was fairly deep. I know several runners that use CA for repair of splitting skin to preclude further injury

Overall most of the responses have been informative and helpful and I take all in consideration.


Edited by Cockroach (10/09/10 12:23 AM)

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#209361 - 10/09/10 08:39 AM Re: Recommended Home/Car suture wound closure kit [Re: Cockroach]
Mark_M Offline
Enthusiast

Registered: 11/19/09
Posts: 295
Loc: New Jersey
I see IronRaven mentioned Celox. I've added Celox to most of my FAKs, but [fortunately] have never had need to use it. Has anyone used it? How well does it work? When should it not be used? The manufacturer's website talks about using it to stop arterial bleeding -- is this fact or fantasy? After use, how soon thereafter should you get hands-on medical attention?

Thanks.
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#209363 - 10/09/10 10:00 AM Re: Recommended Home/Car suture wound closure kit [Re: Cockroach]
Phaedrus Offline
Carpal Tunnel

Registered: 04/28/10
Posts: 3162
Loc: Big Sky Country
Celox works very well. Between my work as a chef and my love of the outdoors I get bit quite a bit. Celox works like a charm, as does it's "sister" the Hemcon bandage.
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#209366 - 10/09/10 01:38 PM Re: Recommended Home/Car suture wound closure kit [Re: Cockroach]
MDinana Offline
Pooh-Bah

Registered: 03/08/07
Posts: 2208
Loc: Beer&Cheese country
For the love of your preferred diety, Richlacal, don't put mashed potatoes in a wound. Or pepper. Or really any other granulated substance. That takes forever to get out, doesn't really help anyway, and isn't sterile in the first place.

NJS makes some good points - very succinct description of the various methods to close wounds. But like others have said, should you close a wound???

Routinely I leave wounds open/packed, with daily dressing changes. Some wounds just aren't amenable to "closing 'er up!" Closing these types of wound essentially leave a festering pocket for bacteria to hang out and systemic infection to start. Do you know how to debride a wound, what antibiotics you'll be needing to give if it's relatively deep, what to do if it's a stick versus an animal bite versus a fishing hook? Even if you successfully close your wound, enjoy your tetanus 2 weeks later, or your sepsis since you treated yourself with the wrong antibiotic.

And like NJS said, how deep is it? It's not uncommon to use 2 layers of sutures, or even 3 or more. Do you have the equipment, skill, pain meds and sterility to be digging wrist deep as you repair muscle, tendons, fascia and skin? Do you know which sutures are absorbable, which will cause a wicked reaction by the body, which ones will cause pain as you heal? Even leaving aside the cosmetic aspect, if you're even contemplating needing a second layer of sutures, you're so much better off either A) waiting for real medical help, or B) packing the wound and letting it heal itself.

Wound care isn't just being a seamstress - there's a lot of factors to take into consideration, and a lot of practice needed to get it right. That's why there's Wound Care Centers, innumerous bandage types, lots of different manufacturers of equipment, etc etc etc. You wouldn't make an industry out of something if some thread and a needle would handle the problem.

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#209390 - 10/09/10 08:54 PM Re: Recommended Home/Car suture wound closure kit [Re: MDinana]
LED Offline
Veteran

Registered: 09/01/05
Posts: 1474
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?

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#209397 - 10/09/10 11:02 PM Re: Recommended Home/Car suture wound closure kit [Re: Cockroach]
6pac Offline
Journeyman

Registered: 09/17/10
Posts: 80
Loc: N.E. Alabama
I carry a styptic pencil, sterile gauze, Tegaderms and a roll of Coban.
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