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Old 05-23-2011, 11:07 AM
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klickitat klickitat is offline
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Default Leaving wounds open to heal.



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I wanted to pass some information along to others that I have learned about wounds.

It is our instinct to close wounds up on our bodies as fast as possible and get them to grow together and heal. This is one of the worst things you can do when it comes to infection.

To most this does not make sense, but what happens is that by closing a wound up that has been exposed to bacteria you are creating a warm and moist environment, a perfect incubator for bacteria growth.

In a survival situation it is best to leave the open open and covered to keep clean to fight off infection. Let it heal from the bottom up. Seeings how infection is a way bigger problem than the issue of a scar this is your best option.

Now this advice is about wounds that are not profuse bleeders and where pressure is needed to stop the bleeding. This is for wounds such as getting cut while fishing or large superficial wounds that have not cut deep into the muscle material.
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Old 05-23-2011, 05:27 PM
thelastboyscout thelastboyscout is online now
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Quote:
Originally Posted by klickitat View Post
what happens is that by closing a wound up that has been exposed to bacteria you are creating a warm and moist environment, a perfect incubator for bacteria growth.

In a survival situation it is best to leave the open open and covered
Wouldn't covering it create this warm and moist environment as well?


Do you have any evidence to persuade your audience of your ideas?
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Old 05-23-2011, 05:50 PM
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I'd take OP's advice with a grain of salt.
Leaving a deep wound open (i.e. not sutured, stapled, etc...) runs a dangerous infection risk, especially given the time frame that it takes to heal closed.
There is also the risk of function loss and/or recurrent pain due to scarring, re-injury from motion or impact is also a problem, inability to do necessary functions due to prolonged healing time/desire to 'favor' the wound which may impact nutrition and hydration, etc...

There is a reason that wounds are mechanically closed, and punctures sometimes packed.

If you lack the means or training to close a wound, at least clean and cover it, and do whatever you can to keep foreign matter and fluids out. Of it was SHTF a prophylactic antibiotic course wouldn't hurt either (again, understand what you are doing with those though.)
Shallow wounds (abrasions, minor burns, small lacs, etc...) can be cleaned and covered with a clean bandage. Regardless, your best chance of preventing infection is to clean a wound once you get it, and keep it as clean and dry as possible while it heals.
Getting some training, no matter how simple (like a Red Cross first aid class) is better than relying on what you read on the internet.
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Old 05-23-2011, 10:34 PM
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Quote:
Originally Posted by thelastboyscout View Post
Wouldn't covering it create this warm and moist environment as well?


Do you have any evidence to persuade your audience of your ideas?
You need to cover wounds or packed in a breathable material to keep it clean and to soak up fluids. they should be changed out every 8 hours. The packing is usually a gauze that is either lightly wetted with saline or Dakons (this is a 5% bleach solution). The packing should be extremely loose. The packing is also just barely damp and is designed to keep the skin on the outside of the wound moist and to keep it from sticking to the wound itself.


As to persuading any, that is not my job, I offered friendly advice for those who would take it. If you choose not to then it is fine with me.
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Old 05-23-2011, 10:46 PM
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Quote:
Originally Posted by ksmedman View Post
I'd take OP's advice with a grain of salt.
Leaving a deep wound open (i.e. not sutured, stapled, etc...) runs a dangerous infection risk, especially given the time frame that it takes to heal closed.
There is also the risk of function loss and/or recurrent pain due to scarring, re-injury from motion or impact is also a problem, inability to do necessary functions due to prolonged healing time/desire to 'favor' the wound which may impact nutrition and hydration, etc...

There is a reason that wounds are mechanically closed, and punctures sometimes packed.

If you lack the means or training to close a wound, at least clean and cover it, and do whatever you can to keep foreign matter and fluids out. Of it was SHTF a prophylactic antibiotic course wouldn't hurt either (again, understand what you are doing with those though.)
Shallow wounds (abrasions, minor burns, small lacs, etc...) can be cleaned and covered with a clean bandage. Regardless, your best chance of preventing infection is to clean a wound once you get it, and keep it as clean and dry as possible while it heals.
Getting some training, no matter how simple (like a Red Cross first aid class) is better than relying on what you read on the internet.
Open does not mean undressed and one should read the entire post before responding.

For those who are reading this with interest. I have a 10"x2"x2" wound in my belly. This wound has been left open for 6 weeks now and it has 6 -9 weeks to go before I get a woundvac installed. When I asked the doctors why, they explained to me the very reasons I left for you in the first post. The same advice was given to me by the doctors about puncture wounds. They said to keep them open at the top and try to squeeze out the infection and let it heal from the bottom up.
Old 05-23-2011, 11:02 PM
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Quote:
Originally Posted by klickitat View Post
Open does not mean undressed and one should read the entire post before responding.

For those who are reading this with interest. I have a 10"x2"x2" wound in my belly. This wound has been left open for 6 weeks now and it has 6 -9 weeks to go before I get a woundvac installed. When I asked the doctors why, they explained to me the very reasons I left for you in the first post. The same advice was given to me by the doctors about puncture wounds. They said to keep them open at the top and try to squeeze out the infection and let it heal from the bottom up.
I did read the whole post.
I understand about your wound, but large abdominal wounds are uncommon and would be life threatening in the extreme in a survival situ.
My job also deals with negative pressure wound therapy (like your KCI woundvac), and something that size is usually the result of trauma or dehisced surgical incision (though it could be something else).
I'm not contradicting your post or your doctors information, just pointing out that what works for your specific wound type, under specific medical supervision, isn't going to be the best or most common thing someone deals with - especially in a survival situation. Hence the 'take a class' part...
Old 05-23-2011, 11:55 PM
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There are smaller wounds that this works for as well.

Here on the West Coast there is a very common thing called fish finger. Most get it from getting cut on salmon teethe when fishing for them. The very worst thing you can do is to seal it up tight with a bandage and even worse than that is to put Neosporan on it. What usually happens it that the skin heals over and the infection grows and many people have lost fingers and hands from it.

The best thing to do is to leave it open and squeeze the puss out until it heals. This also happens with cat bites. Those puncture wounds from a bacteria ridden mouth is something that should left open and not SEALED up.

I am willing to say that maybe there is a little bit of "lost in translation" between us.

Also in a survival situation, large wounds are common. People using axes, knives and machetes and then being around sticks that have been cut out in the woods lead to a lot of mishaps. As a kid small cuts and scratch were very seldom taken care of much more than washing them out and throwing a bandage on them, which we promptly lost as soon as we went back out in the woods.

The only time we ever went in for stitches was when a wound was deep enough to penetrate muscle or would not stop bleeding.

One last thing. My wife got fish finger about 2 years ago and as she was taught, she instantly put neosporan on it and bandage. Within 4 days her finger was healed over, but the infection moved up her hand and was totally inflamed. I had to take a sharp knife and opened the original wound back up and we soaked it in Epson Salts for 20 minutes 3 times a day. After the first 12 hours the inflammation was down and saved us from a trip to the emergency room that next morning. We continued with the Epson Salts soaks and with a Lychen poultice in between soaks. It took about 3 days for us to get things back to normal.

I personally have had fish finger a half dozen times or more and all I have ever done is squeeze the infection out 4 or 5 times a day until it heals. It maybe takes a week to heal and is sore and hurts like hell when you squeeze it, but you do not end up with a bad infection. Soaking in Epson Salts usually helps it heal even faster if you have a bigger fish wound.
Old 05-24-2011, 12:48 AM
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Quote:
Originally Posted by thelastboyscout View Post
Wouldn't covering it create this warm and moist environment as well?


Do you have any evidence to persuade your audience of your ideas?
Have some anecdotal evidence.

My friend was stabbed in the abdomen with a 10 inch kitchen knife. He lucked out. the knife went sideways and missed all the organs.

He ended up with a 10 x 2 inch wound channel in the abdomen muscle.

The doctors left it un-sutured. They stuffed it full of gauze and put a dressing on the outside.

When asked, they said the exact thing the OP said. That bacteria would fester in the wound if they closed it up.
Old 05-24-2011, 01:47 AM
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This is some dangerous ground you are breaking.

You are under a doctors care. If you get septic, you can go to a hospital. There is a HUGE difference between being under a doctors care and trying some advanced wound care in your spare time.

What antibiotics have you been prescribed. How much. How often. Exactly how is your wound being treated when you have a visit? etc. etc.

In my opinion, this post should be deleted because there is a real chance that your advice could cause actual harm. My point is, if you don't have advanced wound care training, please don't post things like this.
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Old 05-24-2011, 02:14 AM
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Quote:
Originally Posted by flickteed View Post
in my opinion, this post should be deleted because there is a real chance that your advice could cause actual harm. My point is, if you don't have advanced wound care training, please don't post things like this.
+1,000,000,000

I appreciate the spirit of the post, but what good is that intention if it ends up hurting someone.
Old 05-24-2011, 02:16 AM
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Quote:
Originally Posted by klickitat View Post
I wanted to pass some information along to others that I have learned about wounds.

It is our instinct to close wounds up on our bodies as fast as possible and get them to grow together and heal. This is one of the worst things you can do when it comes to infection.

To most this does not make sense, but what happens is that by closing a wound up that has been exposed to bacteria you are creating a warm and moist environment, a perfect incubator for bacteria growth.

In a survival situation it is best to leave the open open and covered to keep clean to fight off infection. Let it heal from the bottom up. Seeings how infection is a way bigger problem than the issue of a scar this is your best option.

Now this advice is about wounds that are not profuse bleeders and where pressure is needed to stop the bleeding. This is for wounds such as getting cut while fishing or large superficial wounds that have not cut deep into the muscle material.


Are you a medical professional? This is a serious topic. I have always been taught that you treat the wound to remove all germ's and bacteria and then the complete opposite of what your suggesting. Do you have a credible source on this topic. To be be blunt you could get people killed if your advice is a civil war dated theory that has been disproved. Where's a navy corpsman when ya need one? Doc?

Yes this thread should be deleted. I see there are other like minded people thinking the same thing
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Old 05-24-2011, 04:58 AM
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Quote:
Originally Posted by klickitat View Post
Open does not mean undressed and one should read the entire post before responding.

For those who are reading this with interest. I have a 10"x2"x2" wound in my belly. This wound has been left open for 6 weeks now and it has 6 -9 weeks to go before I get a woundvac installed. When I asked the doctors why, they explained to me the very reasons I left for you in the first post. The same advice was given to me by the doctors about puncture wounds. They said to keep them open at the top and try to squeeze out the infection and let it heal from the bottom up.
I walked through the glass doors in my home many years ago. I looked down and could see the bones. When I was taken to hospital they packed and repacked salt water gauze dressings before operating a day or so later. Always wondered why they took so long. It hurt with every change of dressing ! Thanks for the info.
Old 05-24-2011, 05:30 AM
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The OP is totally accurate as to what is being posted. Wounds that have high risk of contamination should not be stitched up. Animal bites are a good example of this. The dirtier the wound and the harder to clean a wound and remove debris the greater the risk of infection and contamination. Those wounds should be left open so it is easier to do daily cleaning and dressing of the wound. DO not confuse leaving a wound open with dressing a wound. The wound is covered loosely with a dressing so that is can heal but covered to keep out additional contamination. There are instances when a deep wound has to be packed with gauze that has been soaked in sterile saline and changed a few times a day. These wounds are not your everyday cut or scrape type wound they are deeper wounds that have high risks of infection because of either the type of wound or how the wound occurred.
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Old 05-24-2011, 08:37 AM
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I once had an undercoat spray gun hose develop a pin hole right where I was holding the hose. It shot undercoat right through a leather glove into my palm. Made a hole about 1/4 inch X 3/8 inch. I asked my doc why he didn't sew it up, he said you never close puncture wounds completely. A small one like mine you leave open, a large one you sew up but insert a tube to allow for drainage.
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Old 05-24-2011, 08:48 AM
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I have treated a lot of dehisced wounds by packing them with NS soaked gauze. The moist dressing should be followed by a dry dressing and all of it should be changed twice daily. The wounds do heal from the bottom up.
Old 05-24-2011, 09:13 AM
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Everyone should have some silver calcium alginate bandages ....they
Work nicely.

www.silverlon.com/

I have seen them online for reasonable prices.
Just have to google it.
Old 05-24-2011, 09:38 AM
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Believe it or not, but ANCIENT HISTORY has addresed this dilemma. Hippocrates is wrongly considered the father of modern medicine. Actually, the true discoverer of "sterile technique" is IM-HO-TEP...(just like in THE MUMMY MOVIES). Not only was he the grand architect of the STEPPED PYRAMID at SAQQARA, but also a "PHYSICIAN and HEALER".

He discovered that the best dressing to cover a nasty open wound, after it had been cleansed, is...HONEY. Honey is sterile, slightly ascedic...which prevents bacterial growth resulting from invasive infection, and promotes healing. Yeah, its "sticky", but in a pinch where proper and normal antibacterial substances may not be available, this along with a clean dressing/bandage is a viable remedy.
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Old 05-24-2011, 12:13 PM
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Despite all the negative feedback on the original poster, I tend to somewhat agree with him. Now I am in no way a medical professional but have always found in my own case that leaving a wound open after cleaning it always heals fairly well, large or small wounds. If I even use a bandaid I invariably will get an infection on even small cuts. The first thing any observors want to do is bandage one. I very much tend to keep a cut uncovered and purged.

Also I guess I would agree that in an severely unclean environment that an open wound is potentially dangerous. I hope there are always healers around. As an afterthought now I'll have to look up gangrene and it's causes.
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Old 05-24-2011, 02:07 PM
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FWIW, I am a medical professional and can say without uncertainty that "it depends". If a wound is over 24 hours old, we generally do not suture because of the high risk of infection. If it is a fairly large wound, it might be closed loosely, or as the OP stated left open and packed frequently.

We are also looking at the difference in an non healing large wound such as the OP and a fresh wound. We are also looking at anaerobic versus aerobic bacteria growth.

Small fresh wounds should most certainly be cleaned and closed. Closure can be as simple as steri strips or suture and staples.

Even large gunshot wounds, stab wounds etc. when taken to the OR right away are irrigated profusely, given antibiotics, and sutured or stapled.

But if said wound becomes infected or doesn't heal, then frequently they are opened (they never really closed anyway) and debrided if necessarily and left open and packed with moist saline gauze.

So as far as wounds go, you can't really generalize about all wounds.

I am certainly not trying to offer medical advice, but offering anecdotal reports.

I don't think a thread like this should necessarily be closed because good information can come from it.
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Old 05-24-2011, 04:23 PM
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This is called healing by secondary intention. It leaves a larger scar, but Klikitat is right
Sutures in dirty wounds are foreign bodies and 1/1000th the number of bacteria is needed to cause an infection with than without sutures due to the presence of the foreign body. ( A sutured wound is called healing by primary intention)Closed dirty wounds are called abscesses and will drain pus.

Dakins solution is a double edged sword (it is basically Clorox bleach) and is toxic to granulation tissue. It is Ok for a temporary pack of an already infected wound or drained abscess.

I have treated thousands of wounds that were open and contaminated. Tretment was by daily washing and allowing them to granulate closed. They did fine. In face where I trained in the south, the children ralrly wore shoes inthesummer..they were poor..and we saw in the ER about 10 foot lacerations each night. The only one I ever saw infected was the one some jerk decided to suture closed which was against hospitalpolicy. Ploicy then was to soak it each day for 20 minutes, a tetanus shot was given and never had problems.

The rare exception is the face which has such a great blood supply it rarely ever gets infected. And Large wounds on the face are cosmetically unacceptable. Still gross cleansing is indicated.

When in doubt and inexperienced. ...leave the wound open, clean it, dress it and continue daily cleansing. (

(These superficial but basic guidelines are based on 35 years of wound care experience)
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