Talk To Me About Emergency/Survival Wound Closure - Suturing

This is a discussion on Talk To Me About Emergency/Survival Wound Closure - Suturing within the Off Topic & Humor Discussion forums, part of the The Back Porch category; OK - so I am presently practicing very basic wound closure. I am already "up to speed" on preliminary wound cleansing/flushing procedure and I'm practicing ...

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Thread: Talk To Me About Emergency/Survival Wound Closure - Suturing

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    Post Talk To Me About Emergency/Survival Wound Closure - Suturing

    OK - so I am presently practicing very basic wound closure. I am already "up to speed" on preliminary wound cleansing/flushing procedure and I'm practicing a very basic interrupted suture - at this point in time using an O. R. Grade Stainless laceration/suture kit.
    Not the super best quality instruments but, pretty doggone good for my purposes right now.

    I have a variety of Sterile but, slightly expired Veterinary suture/needle packs that I bought for practice and the size 4-0 3/8 needle w/ a non absorbable suture is what I just finished surgically repairing a cut in a Florida orange with. I think the patient will live.

    I am actually quite good with my hands and caught on to it all very quickly VIA YouTube instruction. Probably because I've been hand saddle stitching leather for so many years.

    Are their other better options and/or what else should I include because there are other options available.

    AKA Sterile disposable surgical stapler.

    Surgical Tissue Adhesive

    Adhesive Wound Closure Strips

    I'll also need some sort of ???'caine to numb the skin prior to suturing & it will need to be available "over the counter" since I am not a medical practitioner.
    There is a sterile 5% product used for painless tattooing that looks promising for the purpose.

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    VIP Member Array dukalmighty's Avatar
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    I'll also need some sort of ???'caine to numb the skin prior to suturing & it will need to be available "over the counter" since I am not a medical practitioner
    Bacardi 151 been numbing people for years
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    Quote Originally Posted by dukalmighty View Post
    Bacardi 151 been numbing people for years
    +1 One shot every 15 minutes till no pain is felt.
    When you have to shoot, shoot. Don't talk.
    "Don't forget, incoming fire has the right of way."

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    Quote Originally Posted by dukalmighty View Post
    Bacardi 151 been numbing people for years
    In a 151 Sloe Gin Fizz, it's ever so...numbing.
    A man fires a rifle for many years, and he goes to war. And afterward he turns the rifle in at the armory, and he believes he's finished with the rifle. But no matter what else he might do with his hands - love a woman, build a house, change his son's diaper - his hands remember the rifle.

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    Member Array Eaglebeak's Avatar
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    Wound? What wound? Need more medicine

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    I'll also need some sort of ???'caine to numb the skin prior to suturing & it will need to be available "over the counter" since I am not a medical practitioner.
    There is a sterile 5% product used for painless tattooing that looks promising for the purpose.
    I think you can get lidocaine over the counter or online. That's probably as good as you can do without a scrip.

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    Well, I'm happy that one member is taking this thread seriously.

    Too bad you'all are typing and not talking because if I can suture an orange I can do lips.

    This thread may seem really far fetched to some and that's OK but, I love learning new skills & it will feel good having this under my belt even if I never actually need it.

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    butter fly bandages and super glue have worked for me for years. For numbing I've used ambesol or a product called outgrow it will numb anything made for ingrown toe nail relief.

    p.s. chics dig scars

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    VIP Member Array wmhawth's Avatar
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    Quote Originally Posted by QKShooter View Post
    Well, I'm happy that one member is taking this thread seriously.

    Too bad you'all are typing and not talking because if I can suture an orange I can do lips.

    This thread may seem really far fetched to some and that's OK but, I love learning new skills & it will feel good having this under my belt even if I never actually need it.
    Had you watched Rambo First Blood you would already know how to sew yourself up.

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    QKS . I too just got a medical Suturing kit but have not cracked it open.
    I think it is a great idea to learn to stitch. You never know and the live you save my be mine.

    funny story.
    Good friend of mine is doing his residency program to become a PA. He is working at Harlem Hospital and a guys comes in with a box cutter slice from his temple past his chin. He looks at the guy and then calls the head of the ER. He tells the head of the ER this guy need a plastic surgeon. He looks my friend dead in the eye and asks "Have you ever stiched before?"
    Yeah, pigs feet in school once.
    Ok you are now a plastic surgeon go stitch the guy back up.
    My friend does and sends guy home.

    I asked how well did it come out? He said not so bad for the second time.

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    Great story.
    There are some very good instructional VIDS on YouTube. Some of them seem pretty advanced.
    Break out your suturing kit and give it a shot.
    Then you'll be able to work part time at the local hospital sewing up those gang-banger box cutter slices.

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    Super Glue beats stitches for most stuff and it dosent leave near as much ugly scar tissue.

    Of course, if you are placing guts back in or something of that nature, then stitches would be handly.
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    I really like 3M Steri-Strips for simple wound closure (there are other brands out there but Steri-Strip brand by 3M are the original). When using any kind of steri-strip or butterfly closures you always need to use "tincture of Benzoin" as a skin prep on each side of the laceration. Benzoin is a tacky adhesive which allow the steri-strips to stay in place much longer. It's the same color as Betadine/iodine on the skin but when it dries, it becomes real "sticky" and will definitely keep the steri-strips in place. You can get tincture of Benzoin saturated cotton swabs which comes in packages of three, or some places you can find them in a small crushable vial with a little cotton tip on the end. You can also just get a small bottle of it and tip some Q-Tips in it.

    Dermabond is the medical grade "super glue." The problem is, it's expensive. The price we paid per unit at the hospital ER I worked was either $30 or $60 a piece. They come in those same "crushable" vials with the cotton tip on the end like the Benzoin, mentioned above. I've head doctors say, regular super glue works just as good, and other doctors say that regular super glue is an industrial bonding that is not designed for skin and shy away from it. Either way, Dermabond, or super glue really only works on lacerations where there is no skin tension being applied to the wound. Broad fleshy areas of the skin like the middle area of the inside of your forearm or on the face (cheek area). It won't hold or last long enough on areas with high skin tension like fingers, and joint areas.

    For deep lacerations down into deep subcutaneous fat or large gaping lacerations on a thigh and forearm, simple interrupted sutures won't hold the laceration together well without the risk of pulling back open. For those large and deep lacerations, you'll need to learn either vertical or horizontal mattress sutures. They aren't especially hard to do, but you do need to practice your technique. They go for a deeper bite on the laceration. They are also used with "non-absorbable" nylon or mono-filament suture material and need to be removed when the wound heals. You'll also use a larger diameter suture, size 4-0 or even 3-0 nylon.

    Small diameter sutures thread like 5-0 and the even smaller 6-0 is used for small lacerations like on the face where you want less of a scar. But depending on the size and depth of the laceration, you may still need to use something larger like a 4-0 even if it's on the face. That's where experience and judgement come into play.

    The Chromic or (gut) sutures which absorb and dissolve into the skin over a period of time and do not need to be removed are really only used on very deep lacerations which is down into deep fascia and muscle where you have to close the wound in layers. In those wounds, you'll use something like a horizontal mattress tie using 4-0 or even 3-0 chromic down inside to hold the muscle together and the use regular mono-filament or nylon sutures using a mattress stitch or simple interrupted on top near the surface for the final closing. That type of wound repair is considered advance wound closure and I've never tackled that type of suturing although I can do vertical and horizontal mattress stitches. Fortunately, you don't have to do that type of wound repair very often, but in a survival situation, you get a deep gash from a stray axe or a slip of a chainsaw and you're going to be into serious wound repair.

    One of the most important issue is ensuring you have properly cleaned and flushed the wound adequately before closing it. That really can't be overstated. Especially in a survival situation where you don't have access to getting a tetanus shot. Lacerations from dirty tools like chainsaws, hand saws, knives and machete really need to be irrigated and flushed adequately. Likewise, understanding and learning how to place sutures under sterile technique is very important. You don't want to be dragging your suture thread through dirt and grime as you pass it through tissue. All you are doing in introducing germs and bacteria into the wound and ending up with gangrene is much worse than if you had just duct taped it shut and not even tried to stitch it closed. Bear in mind, in a SHTF situation, you're likely not going to have 10 days worth of antibiotics to put the patient on after suturing it to prevent infection so maintaining a clean and as sterile as possible field when you are working is more critical than you might think.

    Check out YouTube and google for learning how to do your mattress stitches.

    Finally the type of suture needle which is attached to the suture thread makes a big difference in how easy a job it is. Reverse cutting, 1/4 round, 1/2 round, etc are used for different applications when placing different kinds of stitches. FS-2 or FS-3 as well as P3 are some of the more common type of suture needles and will be stated on the package.

    For lacerations inside the mouth or tongue, use Silk suture material. It is a soft thread and the ends sticking out won't poke you inside your lip or mouth the way stiff nylon mono-filament suture does. However, I don't use Silk on wounds outside the mouth as it's more prone to leaching in bacteria. Also for lacerations inside the mouth because of the leaching/wicking effect of Silk sutures you almost certainly want to put the patient on an antibiotic for 7 to 10 days. (or have them use an oral antiseptic like listerine a couple times a day).

    Placing sutures is not something which requires a doctor to do, however, sutures done incorrectly can really cause lots of bad complications, nasty infections and bad outcomes. I don't suture anyone except close family members who I know won't try to sue me if I mess up. Of course in a survival situation you're on your own.

    I've probably sutured 6 or 7 people in the past including my wife 2 or 3 times.

    As far as prescribing antibiotics, using lidocaine to numb the wound and that stuff are all prescription items and if you have any of that stuff in your "kits", just be advised, they are not to be used unless prescribed by a physician. But we all know that up front, right?

    Send me a PM if you need any more information.
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    "The gun is the great equalizer... For it is the gun, that allows the meek to repel the monsters; Whom are bigger, stronger and without conscience, prey on those who without one, would surely perish."

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    Was Super Glue invented to seal battle wounds in Vietnam?
    November 11, 2004
    Dear Straight Dope:

    I was talking to my brother-in-law the other day and noticed that he had a fairly bad cut on his hand, but it looked kind of weird. I asked what happened and he said that he cut it with a carpet knife accidentally and that instead of using a band-aid or other typical first-aid-type product, he sealed it with super glue.When I sounded surprised at this, he told me that his doctor had told him once that super glue came about during Vietnam as a means of quickly closing wounds on the front lines where troops were under fire and had no time to bandage wounds in a more traditional manner. It sounds plausible--after all it does say that it "bonds skin instantly." Is this true or just an urban legend?

    — Scott Matheson

    As with many urban legends there's a mix of fact and fiction in what your brother-in-law said. In contrast to most such cases, though, this one's a lot more fact than fiction.

    Super glue, Krazy glue, Eastman 910 and similar glues are all a special type of glue called cyanoacrylates. Cyanoacrylates were invented in 1942 by Dr. Harry Coover of Kodak Laboratories during experiments to make a special extra-clear plastic suitable for gun sights. He found they weren't suitable for that purpose, so he set the formula aside. Six years later he pulled it out of the drawer thinking it might be useful as a new plastic for airplane canopies. Wrong again--but he did find that cyanoacrylates would glue together many materials with incredible strength and quick action, including two very expensive prisms when he tried to test the ocular qualities of the substance. Seeing possibilities for a new adhesive, Kodak developed "Eastman #910" (later "Eastman 910") a few years later as the first true "super glue." In a now-famous demonstration conducted in 1959, Dr. Coover displayed the strength of this new product on the early television show "I've Got a Secret," where he used a single drop placed between two steel cylinders to lift the host of the show, Garry Moore, completely off of the ground.

    The use of cyanoacrylate glues in medicine was considered fairly early on. Eastman Kodak and Ethicon began studying whether the glues could be used to hold human tissue together for surgery. In 1964 Eastman submitted an application to use cyanoacrylate glues to seal wounds to the United States Food and Drug Administration (FDA). Soon afterward Dr. Coover's glue did find use in Vietnam--reportedly in 1966 cyanoacrylates were tested on-site by a specially trained surgical team, with impressive results. According to an interview with Dr. Coover by the Kingsport Times-News:

    Coover said the compound demonstrated an excellent capacity to stop bleeding, and during the Vietnam War, he developed disposal cyanoacrylate sprays for use in the battle field.

    "If somebody had a chest wound or open wound that was bleeding, the biggest problem they had was stopping the bleeding so they could get the patient back to the hospital. And the consequence was--many of them bled to death. So the medics used the spray, stopped the bleeding, and were able to get the wounded back to the base hospital. And many, many lives were saved," Coover said.

    "This was very powerful. That's something I'm very proud of--the number of lives that were saved," he said.

    Ironically, the Food & Drug Administration hadn't given approval for the medical use of the compound at that point. But the military used the substance, anyway (reference 1).

    Although cyanoacrylate glues were useful on the battlefield, the FDA was reluctant to approve them for civilian use. In part, this was due to a tendency of the early compounds (made from "methyl-2-cyanoacrylate") to irritate the skin as the glue reacted with water and cured in the skin, releasing cyanoacetate and formaldehyde. A compound called "butyl-2-cyanoacrylate" was developed to reduce toxicity, but suffered from brittleness and cracking a few days after application. Finally an improved cyanoacrylate glue was developed for medical applications called "2-octyl-cyanoacrylate." This compound causes less skin irritation and has improved flexibility and strength--at least three times the strength of the butyl-based compound (reference 2). As a result, in 1998 the FDA approved 2-octyl cyanoacrylate for use in closing wounds and surgical incisions, and in 2001 approved it for use as a "barrier against common bacterial microbes including certain staphylococci, pseudomonads, and Escherichia coli" (reference 2). This latest incarnation was marketed under the name Traumaseal as well as the more popular Dermabond.

    Cyanoacrylate glues also find use in medicine for orthopedic surgery, dental and oral medicine (marketed as Soothe-n-Seal), veterinary medicine (Nexaband), and for home use as Band Aid brand Liquid Bandage. It even has been explored as a potential treatment for emphysema, where it can be used to seal off diseased lung passages without the need for invasive surgery.

    Is it safe to use ordinary household cyanoacrylate glue as a medical glue? According to Reference 7, most cyanoacrylate glues not designed specifically for medical use are formulated from methyl-2-cyanoacrylate, since it produces the strongest bond. Not only can such glues irritate the skin, during polymerization they can generate significant heat, to the point of causing skin burns. I gather this is a problem only if a large area of skin is affected. But to err on the side of safety, you should tell your brother-in-law he should only use medically-approved glue, not the ordinary kind. And always be careful using it--I know families are supposed to stick together, but there are limits.

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    Member Array TheGiant's Avatar
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    Talk To Me About Emergency/Survival Wound Closure - Suturing
    No just Don't do it!
    I really don't want you playing "HawkEye" on me just put a tourniquet on it and get me to a real Dr.

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