I carry a dozen butterfly closures. easy to use, they work and will not be as painful to apply! If there is a wound that is beyond their capability, the patient needs to be treated by a pro. Lots of 4x4 bandages, kling gauze and butterflys, that is my prefernce.

WARNING: for informational purposes only. Do not attempt without proper training!

Ethicon Suture Manual (everything you wanted to know about suturing and probably more.) http://www.jnjgateway.com/public/USENG/Ethicon_WCM_Feb2004.pdf [color:"red"] [/color] [color:"red"] [/color]

For most situations you are best not closing the wound and just stopping the bleeding, cleaning the wound and then dressing it with sterile bandages. Closing wound in the wilderness and other non sterile environments will increase the risk of getting a foreign object in the wound.
If you must close a wound most untrained folks are best using wound closure strips; you can improvise this with duct tape.
There is actually no need to suture; most wounds will heal on their own. Stiches are mostly used to prevent excessive scaring and are best left to professionals.
Unless you are an RN, medic or MD you don't need sutures.

Finally! An answer to my question. Thank you Marduk!

3-0 monofilament.........check!

My background: Army Medic x 5 years, Physician Assistant 7 years - I've seen/treated a lot of wounds.

Suturing is deceptively simple - it's a relatively easy skill to learn, but takes a bit of practice to perfect. First, you really should have some training. Through training you'll discover that irrigating your wound w/ betadine, peroxide, alcohol, etc... are no-nos - all retard wound healing and damage healthy tissue to some extent. You will also learn proper closure technique - including wound prep (irrigation, debridement, local anesthetic choise & usage), suture selection, placement of sutures, types of sutures, types of knots, etc... Unfortunately, this type of training is not something you find at the local YMCA. It's typically available only to those whose professions demand the skill - physicians, nurse practitioners, PAs (in some areas "advanced practice" paramedics, and occasionally nurses - although these skills are not typically used by such)

Most wounds will heal fine w/o sutures - even very deep ones - as long as they are cared for properly - regular dressing changes, packing if necessary, etc... (again, this is covered w/ proper training).

So if wounds heal w/o sutures, why do we suture wounds? Sutures offer a few benefits:
- they produce cosmetic result (generally) than healing by secondary intention
- they restore function to torn ligaments/tendons/fascia (when used properly
- they speed the healing process in clean wounds (they decrease the degree of epithlialization, as well as contraction, needed to heal a wound)

The major pitfall, especially in traumatic wounds, where the degree of cleanliness may be questionable, is an increased risk of infection. Some infections are minor, and will be contained/eliminated by the body's immune system adequately. Some require opening the wound to allow for drainage. Some are life-threatening, and require extensive tissue debridement & antibiotics (do a search on necrotizing fasciitis - you can get a similar infection from a simple scratch).

my personal opinion - don't suture in the field - you more than likely will not be able to maintain a clean field, much less a sterile one - you are going to drag contaminated material (the suture) through the wound, innoculating it w/ bacteria (unless you have been trained in aseptic technique, and brough along a sterile drape, sterile gloves, etc..). don't use superglue in the field (it's not the same as Dermabond, either). Irrigate w/ the cleanest water available, remove any debris, irrigate again cover w/ dry dressing, monitor for signs of infection (redness, swelling, increased pain, increased temperature, drainage), seek professional care. Closure of minor lacerations may be possible w/ steri-strips or buterflies (or strips of tape, etc...) - many wounds can be closed this way, and since the skin is not artificically sealed, it can drain as needed (and if it becomes infected, you can easily remove the tape/steris/etc...

All that said, probably the best all around sutures to have would be 3-0 & 5-0 nylon (3-0, 5-0 refer to the size of the material, 3-0 being significantly larger than 5-0) on a cutting needle (sutures come on a variety of needles - cutting are used for skin, where tapered needles are used for more delicate tissues). 3-0 is fine for most parts of the body, and 5-0 would work for palces like the face, hands, etc..., where you would want to minimize the scars appearance. Really deep or long lacerations will probably require more than one layer of sutures, or something likea vertical mattress suture to close properly - again covered in formal training (or informal if you can find someone truly knowledgeable on the subject who is willing to teach you).

Stay safe

Flotsam:

Thank you for your very thorough post on this subject. A few questions:

Betadine and other cleansers are not used in the wound, but for the surrounding tissues...correct? Flushing a wound with sterile water is good once the wound is cleaned of debris? What about the use of treated water, (iodine) and what about the use of Neosporin or other antibiotic ointments?

The reason I want a couple of sutures in my PSK/FAK, is to offer another treatment option; not necessarily for me but for someone else to administer as well (like someone with more experience). During a backpacking trip years ago, I cut my hand in an area where a butterfly bandage would not work. I was not coming off the mountain for a week, and I needed the use of my hand, so I cleaned it, and sutured it myself with monofilament and a sewing needle (just four sutures), covered it with Neosporin, gauze and duct tape. By the time I was off the mountain a week later it was almost completely healed. Had I not sutured the wound, it would have been a major pain in the a** for the entire week.

While most wounds may be closed with bandages, I'd rather have a couple sutures in my kits, just to have that added option of treatment.

In that case, a stapler may be easier (and more hygienic) to use. I know that Ethicon makes several staplers that are affordable (around $10), that have either 5 or 15 staples, and are fairly compact. mooremedical.com is a good source. It's very hard to keep a sterile field in the boonies - w/ a stapler, you can keep a clean work environment & reduce the risk of bacterial innoculation.

Irrigating w/ treated (potable) water is fine, and at least one study has shown that the results are just as good as irrigation w/ sterile saline (considered the "gold" standard). Application of bacitracin is fine - and you really don't need to apply more often than 2x/day. I would avoid it if the skin appears macerated. Plain soap & water is fine for cleaning a wound as well.

If you ever have the occasion to use a real suture needle, it's much sharper than the average sewing needle (the cutting needles have 3 sharpened edges that work as blades to cut through the skin, making driving the needle much easier).

The best thing you can do is find someone who does this regularly, ask them to show you how to do it properly, and then practice (I used pig's feet in school). A set of "floor grade" instruments is pretty cheap, and you could practice w/ expired sutures (often available cheap off ebay)

I once had to suture a deep cut on my calf (leg, not young cow) myself. I couldn't get it to stop bleeding, and butterflies wouldn't hold because of the stretching of the muscle when I walked. Fortunately I had been carrying a couple of sutures in my FAK. It ended up working out great, gave me full mobility and healed in record time.

The location of the cut made it very difficult to do - you need both hands. If it had been an inch further back, I probably couldn't have done it. Because of that I now have a skin stapler as well as sutures in my FAK. The sutures are a general purpose 3-0 monofiliment with a curved cutting (FS-1) needle.

Later on, the first question everyone had was "didn't it hurt to do that?" Well it already hurt, the suturing was minor. Cleaning it out was another story. A lot of gritting teeth and Arrrghhs. A bottle of saline solution for contact lenses would have made irragating the wound a lot easier. If you wear contacts, you should probably have that with you already. If you don't wear contacts, it's a good idea anyway. You can also use it to get dirt, bits of debris, ash from the fire out of your eyes.

There was already a link to the Cabela's skin stapler and staple remover kit. Most staplers are big, honking, hand filling things. The DS-15 in the Cabela's kit is really compact, and it beats trying to tie a not in an awkward position.

When in doubt, pee in it. Unless you have a bladder infection, urine is sterile. If you're squimish, use your own.

Flotsam is so right. good info.

5.0 is about the same as 23 guage. This s*$#t is like a razor. Good for deeper layered surtured wounds which i hope the un-trained won't try. Please don't use duct tape to close a wound, It doesn't allow for seepage and actually keeps the germs condensed in a small area. i did a search and found a good source of info on sutures Take a look http://www.emedicine.com/ent/topic38.htm

There are a lot of different opinions on this, learn what you can and make your choice. I still think that 3.0 which is around 14 gauge is the smallest most people wan't to go. if I'm wrong please say so.