since suturing is a perishable skill and besides the sterile technique and different types of stitch and suture materials necessary I recommend cyanoacrylics (dermabond).

Clean it up really good, and glue it back together.

Wound closure should be done within a few hours or you run serious risks of infections.

 

It's quiet interesting that you bring this up. I was just reading up on perishable vs durable skills and this raised a question for me.

My understanding of perishable vs durable skills is that perishable skills involve cognitive processes which can not be repeated over and over and stored as muscle memory. Durable on the other hand is its exact opposite, they are tasks which can be repeated and ingrained into muscle memory, not requiring cognitive abilities to complete them.

If that is in fact the case. Which it very well may not be. Couldn't it be argued that certain skills in part could be durable. Such as suturing itself. For instance placing interrupted sutures to close a wound. The suturing it self as far as placing the suture and tying the knots or placing the suture and using a barbed suture could be thought into muscle memory. The part that would require the cognitive aspect would be the type of material, the type of needle but the techniques of placing the sutures them selves could be learned regardless of the material and needle being used as far as basic suturing is concerned. For instance closing a small cut on someone's face or arm that would only require 2-6 stitches.

I may be just complicating the entire situation I'm just curious if parts of a skill set can be durable of other parts are perishable or if because one part is perishable then the entire skill set must be perishable by definition.

I'm not an expert by any stretch of the imagination on this subject which is why I am curious. Thank you for brining this up!

 

Dermabond is one brand, but glue is the way to go.
I'm having docs use it to close c-sections (after deep tissue stitching), lap surgical incisions, plastics, lot's of stuff.

I have glued so many lacs... works great. Just make cross marks so you line things up...

 

I totally forgot about glue when I wrote the post! Awesome call!

Do the glues include some form of antiseptic or are they just an adhesive with no other properties?

I ask only because I'm trying to figure out what would be best in a survival situation where resources might be limited. In the example you gave about the c-section you said they did deep stitching before using the glue. From what I have read suturing could lead to more severe infections if the wound is not cleaned properly before closing. So if the glue is strictly adhesive and the wound wasn't cleaned properly, wouldn't suturing before applying glue only increase your chances of infection?

If I am missing something please let me know!

 

Flushing and drains are important also, when approximating wounds.

I keep staple kits, saline and glue around and have used them on myself and my hound(s).

I grab the "expired" sterile saline and dressings that gets chucked by the paramedics at work; it's great for flushing out eyes and wounds and wicking out deep, closed wounds.

*( keep wicking drains covered, as bacteria can migrate back, via osmosis. )

A good resource: http://www.woundcareshop.com/AquacelAg420128.aspx

 

if your going to have the stuff to suture, why would you not have disinfectants?

part of the wound closing procedure is cleaning the wound......... I really wouldn't skip that step.

Oh and I would probably go ahead and get a tetanus shot now.......... just sayin:thumb:

 

if your going to have the stuff to suture, why would you not have disinfectants?

This raises an important question for me. Just as Guntoteninfadel pointed out why have one without the other? In a survival situation i could understand how you may not have access to the proper antiseptics you would need to properly clean a wound. But from a prepping perspective what is the right antiseptics to have stored?

My initial thoughts say to have Alcohol (70% and 91%), Iodine (10%-20% Povidone), Chlorhexidine Gluconate (4% CHG) and CHG 4% w/ Alcohol 70% along with hydrogen peroxide 3%. And of course soap and water and hand sanitizer for asepsis and sterility.

But am i missing any or do I have too many and could manage to slim down my list? I'd love to hear what everyone thinks on this subject for both a survival situation post-SHTF and for a normal current everyday example.:thumb:

 

i'd have them all. use the correct one for the given situation.

 

i'd have them all. uses the correct one for the given situation.

Exactly. It all depends on the wound you're trying to repair. Steri-strips won't hold deep tissues together, and sometimes nothing but staples can get the job done if you can't get a good anchor for sutures, but stapling, although faster, can come with more risk of infection in some situations, and you can't remove them later with just anything that can cut. You can also end up needing two people to place them well--one person can suture well. At the least, I'd have both steri-strips and some sutures available for a serious medical kit.

 

Might want get some local if you plan on suturing or stapling. Most people could not handle the pain

 

Ice / ice packs go a long way if left on long enough and the area is not too dense with nerves. Hand and foot wounds are brutal without Lidocain.

 

Iodoform drain, leave the tail hanging out. Remove once it is obvious there is no infection and healing has progressed sufficiently.

 

They all can have a place, especially super glue which I think is the most useful...Small, easy, takes literally a minute. It is great for minor hand lacerations, keeps them from staying open and hurting/bleeding for days.

Staples are great for scalp lacerations, and sometimes for long linear lacerations when sutures would take forever. Steri strips always seem to fall off or not hold edges together well enough, but they can be used to reinforce things closed with superglue.

Sutures are the only method that both can be used to close any wound, and for certain wounds should be the only one used (very deep, or mucosa lacerations). But they're actually not as useful as they seem. Not all wounds are appropriate to close, and especially if it's with sutures in SHTF conditions.

Minor lacs can be superglued which is much easier and safe. Otherwise they can just be left to heal open, also possibly safer than suturing, just takes longer to heal. Deep complicated wounds need certain suture needle styles, material, methods, etc. Closing thesea wrong can make them much worse and be a big problem if there are no hospitals or IV antibiotics.

The Wilderness Medicine Society's current position on sutures in "austere environments" is overall slightly against it. I think it also applies to the SHTF world and outside a hospital. As a physician who has closed wounds with sutures on outdoor trips twice before, even I don't bother with it anymore. Glue is fine. Suturing a friend's finger back together in the middle of nowhere seemed to work out great and save our whole trip, but I've learned enough now to see the risks of that mindset and how hard it is to get beyond having "just enough knowledge and training to be dangerous."

Remember this WEM journal case: They Had Me in Stitches. If even an anesthesiologist and orthopedic surgeon can't use these skills/tools wisely it doesn't seem there are many people who could.

 

Does anyone know of a place where you could purchase sutures and have them delivered quickly?

I have a place where i have purchased sutures and a whole range of medical items but as far as sutures go the types i have tried to order take 14-21 days after purchasing before they are shipped to me.

The type of sutures i have gotten before are Covidien absorbable and nonabsorbable sutures. And i have recently been looking into getting Covidien V-loc sutures but the site i purchased the other sutures from doesn't carry the v-loc sutures and i don't want to wait 2-3 weeks for them to arrive. Plus Amazon doesn't carry anything but practice sutures.

Does anyone have any advice for me? Or a place I can look at that could deliver quicker than 2-3 weeks?

 

1. Use the least invasive repair necessary. A small wound if you can close it with a bandaid then don't suture it.
2. Use the method that works best for you. If you have never sutured a person, probably not a good idea to start.
3. People here mentioned glue. Glue should not be used on "dirty wounds". We use it in surgery in a sterile environment on otherwise clean wounds, not punctures, bites, bullet wounds, knife cuts, crushing injuries... Those wounds are typically closed with interupted stitches or staples to allow for wound drainage. It is not to be used on areas of the body that bend as the glue will crack and fall off. Also glue should not be used on body parts that get wet such as armpits, groin, feet.... Never used on mucosal/membranes. ***It is for skin closure it is not going to hold up for days without sutures if there is a large deep wound*** Deep tissue wounds need to be closed from below first.
4. Staples are great, but know how to remove them. there are many ways, but don't put them in if you don't know how to get them out. Added advantage of being able to remove slowly such as every other staple to test the integrity of the healing wound.
5. Know what suture you are using, and what it is good for. Nylon is not for internal use, but only skin closure. Know the anatomy, I'll assume most don't have experience with sutures... don't hit a nerve or artery when passing the stitch. Know how to tie the stitch. Learn simple interupted or mattress stitch. This will be the most useful SHTF.
6. In an emergency SHTF situation, take some fishing line, and boil it 20 minutes, and you have yourself some suture material. Now all you need is a free needle to sew with.
7. Remember to take out the suture after about 10 days i they are not absorbable. Leave tails long enough so you can grab them and not have to dig through the scab.

 

3. People here mentioned glue. Glue should not be used on "dirty wounds". We use it in surgery in a sterile environment on otherwise clean wounds, not punctures, bites, bullet wounds, knife cuts, crushing injuries... Those wounds are typically closed with interupted stitches or staples to allow for wound drainage. It is not to be used on areas of the body that bend as the glue will crack and fall off. Also glue should not be used on body parts that get wet such as armpits, groin, feet.... Never used on mucosal/membranes. ***It is for skin closure it is not going to hold up for days without sutures if there is a large deep wound*** Deep tissue wounds need to be closed from below first.
5. Know what suture you are using, and what it is good for. Nylon is not for internal use, but only skin closure. Know the anatomy, I'll assume most don't have experience with sutures... don't hit a nerve or artery when passing the stitch. Know how to tie the stitch. Learn simple interupted or mattress stitch. This will be the most useful SHTF.
7. Remember to take out the suture after about 10 days i they are not absorbable. Leave tails long enough so you can grab them and not have to dig through the scab.

Three very important points!

Especially number #7 as i have learned with improper tail lengths you can cause a lot more harm than good when removing them.

Number #3 reinforces my question about antiseptics. I currently have all of the antiseptics I listed above (Alcohol, Iodine, CHG, CHG/Alcohol and Hydrogen Peroxide). What other antiseptics or antiseptics supplies should I have stocked?

 

I'll add a couple of thoughts to much of the good info already here.
1) "The solution to pollution is dilution" Flush wounds with saline if you have it or tap water if you don't. Irrigate irrigate irrigate before closing.
2) Avoid closing wounds older than 8 hours, infection is almost a guarantee.
3) I like vertical mattress sutures, it gets the deeper layer and aligns the skin edges as well. And proves some hemostasis as well.
4) Staples are ok, quick and easy for closing skin and subq I don't like them for scalp wounds because scalps bleed so much superficial closure is likely to allow a large hematoma.
5) Delayed primary closure on the 4th day is one way to reduce the likelihood of infection in an initially contaminated wound. (bacteria count proven to be lowest on day 4)
6) Many wounds can be treated with open packing with moist gauze, and a wrap. The body will contract and fill them with granulation tissue over time...patience required here.
7) If a wound does become infected, as indicated by redness, (cellulitis), pain , drainage or pus, and warmth. It is best to open it widely and allow it to drain clean it out and pack it open.

 

suturing

My suggestion is to buy a few packs for real use in your kit and make some practice sutures with 23 Ga hypodermic needles and 8 Lb mono. That way you can practice whenever you like without spending a bundle and practice fine motor skills threadding the mono into the needle. Something that very few people do

 

I've heard of people closing scalp lacerations by taking some hair on each side of the wound and tying it together like sutures. I don't know of anyone who has tried it. One also should have a way of cauterizing blood vessels as scalp lacerations have a habit of bleeding heavily

 

That's an interesting point you raise about cauterizing wounds. I would assume that this is a last resort method of stopping bleeding. If possible i would think you would attempt to stop the bleeding with other methods such as applied pressure or packing the wound with gauze (which again would be pressure) or using a clotting agent to speed the process up. But if those failed cauterizing could be used to stem the flow of blood.

My first reaction says to have something that would be clean as well as controllable with respect to temperature. For instance a soldering iron but if that wasn't an option perhaps an oxyacetylene torch to heat a piece of metal to apply to the wound.

What other options would there be to cauterize a wound? If you really didn't have any other option you could use a piece of wood that is burning but that would embed ash and debris in the wound along with cauterizing it. I guess the best option would be to build a fire and use the fire to heat the piece of metal you would have used with the torch.

My real question is what other survival options are there out there?

 

Last time I got a tetanus shot it was only available in a combined mix with Diptheria and Pertussis immunization, and neither medicare nor my medical plan would cover it.

 

My Suggestion is to use Monsel's Solution to stop bleeding, then clean with beta dine solution to kill any bacteria. If the wound if long and deep sutures to hold sub-dermal tissues in place and 000 gut for the epidermis. Any injury involving muscle tissue really should be sutured in close tight stitches. For gashes less than 3/4" you can use Cryocygenic glues and yes they are sterile. They are very strong. the downfall is infections. Its almost impossible to re-open to clean and disinfect. Sutures can be removed and if necessary open the wound to address any infections. Staples are pretty much for head and scalp injuries which are shallow but bleed profusely .

One the best items to have for any first aid kit is Monsel's soltution!

 

Just saw an interesting duct tape application for this... probably within the last 36 hours. Unforunately I can't find it now. They used tape on either side of the wound. About a quarter if an inch away from the wound, there was a flap where the tape had been folded on itself so it wasn't sticky. The two flaps were then sutured/sewn together using large, well-spaced stitches. The method pulled the flesh together without occluding the wound or adding new punctures. If anyone else has that link, please add it to the discussion.

 

Here is an example of the duct tape suture you were talking about in a YouTube video. If this isn't what you were taking about please let me know but I'm pretty sure this is what you were referring too.

https://youtu.be/VDMAZMAgIIE

 

I keep 2 sizes of butterfly closures and steri-strips around. Both will close a wound pretty well if its not that bad.

I had a scalp wound about 5 years ago, 2.5" long and bled quite a bit. In the ER they used steri-strips and applied this glue... which went on cold... ahhhh... but turned white-hot for 90 seconds while it cured... ARRRGGGGGHHH. The glue was in a single shot pen dispenser. I looked them up om Amazon, pricey but possibly worth having a few around.

 

It all depends on the wound. Don't need stitches in a band-aid situation...

 

The act of stitching might be all you can do. Knowing how to do it and how to keep everything clean is of primary importance. You can stich with all types of thread, but a good cotton thread, or even dental floss can do the job. Having a stapler or glue on hand is great, but knowing how to close a cut without those colud be a life saver.

 

While in the reserves as a medic, and in couple classes on Emergency First Aid, I was taught that the sewing of flesh is not for field work, (Rambo, take note). Adhesive tape in three or four inch lengths can be cut twice from the side about an inch apart on both sides, (four cuts), one third of the way across, then the sticky part of that middle folded against itself so no sticky is exposed, and the two tails touched/stuck to clean skin while wound is pushed/pulled together, the non-sticky part now over the wound.

This allows someone with real training coming along later to cut the middle off while actually suturing without pulling on skin around possibly weak wound healing/scab.

 

You could do like the mother in Old Yeller, and sew it up with a hair from a donky tail.

 

Does anyone know of a good location to get sutures from?

I have tried a couple different sites with some success but each site has limited stocks and varying delivery windows. I am looking for a place that stocks a wide variety of sutures and will ship them quickly as opposed to having to wait 2-3 weeks before being shipped out.

If this is a normal lead time then that's all i need to know but but i have a feeling that 2-3 weeks is a bit long to have a box of sutures shipped.

Any direction would be awesome here!

 

Is there any significant different between Dermabond (or other 'medical' grade glues) and the cyanoacrylates used for home use? That is what I've used for years on cuts to fingers, arms, legs. I typically attempt to leave a small area at the end of the cut unglued to allow for drainage. Yes, I always clean, clean, clean first.

 

for deep lacerations on me, arms and hands, staples. superglue is my next choice, third stitches.