Wound Closure Safety Guidelines. Do not attempt any of these techniques unless you are in a WORL, SHTF, TEOTWAWKI situations. If you can get to a Doctor get them to do this. Trying this at home is asking for all kinds of complications.
It seems everyone in the world wants to know how to perform sutures. As if it will be the end all be all to saving a life. Wounds will heal up on their own. Knowing how to suture will only keep the scars to a minimum. Not only that but there other methods of approximating a wound besides suturing.
Wound Closure Considerations
You might as well know some things first. Knowing when not to suture is of the utmost importance. NEVER suture or close any wound that is dirty or infected. Now you can flush and irrigate the wound. Water will get out a lot of the bad stuff that will later cause infection. CLEAN THAT SHIT OUT. If it is clean enough to drink it is clean enough to irrigate.
Any chemicals or bites (especially human bites) require approximately 15 minutes of irrigation. If the area gets infected and you suture it up… then you just did more harm. Not cool.
Where to Suture
Do not suture in a wilderness or combat setting. If you need to close a wound steri strips or super glue will work just fine. Suture only in indoor settings (preferably sterile). I do not pack sutures in my aid bag for field use.
Wound Closure Infection
So how do you know if a wound is infected? Well it will be warm, red, and inflamed around the area. Horrible smells are a dead give away.
Now you want to let wounds heal from the inside out. So for a gun shot wound or any wound that is deep you want to not close the wound. You want to place wound packing material in the wound. There are nurses whose professional lives are dedicated to wound care. So I am going to say simply if this isn’t a simple cut from a small blade… Don’t even think about closing the wound yourself. So let’s say you are going to close the wound. Here are your options; STERI-STRIPS
- PROS: Less invasive, Easier to learn.
- CONS: Less effective on larger wounds. Best for surgical wounds.
First thing after you irrigate the wound clean the surrounding tissue. You want to clean away from the wound. Bacteria is cold chilling on your skin and it is waiting for you to get cut so it can have a happy life infecting your ass. So don’t give it that chance. Clean the area like you are scrubbing your balls for a date… (ladies since you don’t have balls imagine how vigorously you want those balls scrubbed on a date and do that)
Second thing is you want to dry off the skin surrounding the area. Again away from the wound. Next apply Tincture of Benzoin to both sides of the wound. This will aid in the adhesion of the steri-strips.
Steri Strips are all together so you can put them on one at a time like a chump or figure out how many you will need and apply them all at once. Guess which one I prefer?
Now you with a free hand not touching the cleaned area you are going to pinch the area you want closed and close it the best you can. If the edges of the wound don’t touch then Steri-strips aren’t going to help.
Then you just apply the whole thing like you would a simple band-aid. Then booyah you are done. Simple huh.
This video shows how to do it. But again they do it one at a time like chumps. Steri-Strips can be used in conjunction with other techniques so it is cool. You can also throw Tagederm or even wrap the area with saran/cellophane wrap.
Before we go on let me address this next part. Pain. You want to manage the pain of your patient with local anesthetic. Chances are if you have Lidocane (you can buy it on Amazon) you will run out at some point. Lidocane also requires you to give injections. You also need to ensure your patient isn’t allergic. Complicated stuff right. Well there is what is known as ghetto lidocane. That would be a constriction band placed proximal (between the wound and the heart) until the effected area goes numb. This technique will save your lidocane in case you need it for the face or the head.
To give lidocane you are going to draw it up with an 18 gauge needle into a syringe. You are going to then take off the needle and replace it with a 25 gauge needle. You care going to clean off the surround tissue with alcohol or iodine (make sure the person isn’t allergic to that either) and you are going to liberally inject the subcutaneous area surrounding where you intend to staple or suture. Or you could tell them to cowboy the F* up and just take it like a man. That isn’t nice. STAPLES;
- PRO: Easy to use, Strong as sutures.
- CON: Causes additional scarring.
Staples are more invasive than sutures. They are just as strong but they produce additional scarring. The benefit is that it is easier to learn. Pretty much if you can staple paper… you can staple a person. Use the same precautions you would use for suturing. Get the medical staples not the stuff you get at the hardware store. This has to be sterile so… You could sterilize it with a lighter but your patient will hate you and probably want to kill you. Not recommended.
Use the above steps for cleaning and approximation of the tissue. It is that easy.
Dermabond or Super Glue: You can use Dermabond or super glue in addition to sutures,staples, or steri-strips
Okay now we get to the fun stuff. Like your shotgun the smaller the number the bigger the needle and sutures. So the smaller the surface the bigger the numbers need to be. Duh. 4-0 is a good way to go. Not too big… not too small. So if you are only going to buy one box get these.
There are plenty of types of suturing material. Ethilon (Nylon) sutures are the best for the basics. If you use the absorb-able sutures on the surface then you risk infection. Those are for surgery only!
This video is good. My one critique of this would be that they should start from the middle and then divide and conquer. If you run out of suture material mid way through then you can use steri-strips and dermabond. Another thing is you want to pull all your knots to one side so they are easier to remove.
After you are done with all this I highly suggest that you make sure the wound isn’t going to get infected. So monitor that. In 7-10 days you will have to remove the sutures and/or staples.
Suturing is a skill that you must practice… A LOT. Before you do this on a real person practice a lot on meat. Chicken, Pork, Beef… It doesn’t matter. You want to practice. If you go too long without doing this you will suck at it. People will judge you on your ability to suture and give IV’s as a medic. So please do not fuck this up.
Now how would one go about getting the materials? I don’t know. As a VET I wish there were some kind of SUPPLY store I could go to… But if you are resourceful I am sure you can find most of this in a tackle box.
I really recommend you not attempt these skills. They will cause more harm than good if done wrong. But people do not care. It is admittedly a very sexy skill to have. Also I will admit I am not a wound care specialist. I am not a doctor. I am probably vastly under qualified to teach this. Anyone who is qualified probably won’t teach you for all the reasons I mentioned.
I am operating under the assumption that you are going to do what you want to do regardless of any warnings to the contrary. In writing this I hope that if you are going to not listen to reason that I can at least make you not suck. I do not endorse the performance of any of the above techniques on human beings so long as there is a legal system in which I can be sued.
I did not mention sterile fields or sterile technique because chances are you don’t have access to all the equipment to sterilize things and chances are if you ever get the opportunity to do this for real then things have gone so side ways that it would be impossible.
I am going to write another article on basic wound management. Because these things go hand in hand.
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