James:
After reading David in Israel I had a few further suggestions. All open wounds do not have to be sutured, in fact most wounds that are dirty should not be sutured but allowed to drain, and heal by “secondary intention” or basically healing from within. Not all soft tissue wounds need to be cleaned, and dead and nonviable tissue trimmed away. Abscess and further extension of infection can occur with a dirty wound that it sutured closed. Wash with copious amount sterile water, dilute betadine, or dilute hydrogen peroxide. Non dilute solutions often can cause more damage to the tissue than necessary. Straight bleach, rubbing alcohol, vinegar are all too strong and will cause additional damage. Oral or IV antibiotics may be needed during this time. Now organ lacerations are a different animal, particularly with bowel wound, these need to be isolated and repaired. Obviously only a well trained person will be able to do “surgery” to this extent. Leaving sutures in can scar, so a rule of thumb is 10 days for most wounds, 7 for thinner skin, and 3-5 on the face. Obviously scar formation is less of an issue in a SHTF case, and some wounds may need to be over sutured in order to transport a patient over rough terrain etc, but these will need to be followed closely and even allowed to drain.
Staple guns work great, and pretty much anyone who has had surgery recently has seen how widespread they are used. Highly vascular skin heals just as well with staples as sutures.
Dermabond or cyanoacrylate works great for small wounds, I have even seen some ER docs use this over suture which I do not recommend as it is very difficult to remove the sutures, but makes for a strong barrier. – Mike M.D. in MO
Jim:
David in Israel gives some unfortunately common, and bad advice about suturing. Unless you know (like a physician or physician assistant/nurse practitioner) what is UNDERNEATH the skin, and how to suture them back together, untrained people should NOT close wounds.
The body is made of layers of different tissues – skin, fascia (underlying tough fibrous tissue), muscles (in several layers, usually) and other things, like blood vessels, nerves, and organs. Each of these layers has different ways of being sutured, requiring different types of suture materials and needles, and just sewing the skin closed will allow blood to leak out of vessels and decay, causing infection.
The best thing for the untrained to do if there is a deep wound is to wash it out (as David in Israel said) with clean water or saline solution (a teaspoon of table salt per quart of water), maybe with some Povidone/iodine (Betadine solution (not scrub), and then pack the wound loosely with gauze and let it heal from the inside out. Such healing will take much longer and leave a worse scar, but closing prematurely can be disastrous.
Other closure techniques (glue, staples) are great within their limitations. Glues should not be used on wounds under stress, and staples are great for small skin or scalp lacerations. Neither addresses closing the underlying tissues.
Even in normal times, a minor wound that has gone for more than a few hours (six hours, in my hospital) is left open for at least a few days, to make certain that no foreign materials are trapped in the wound, and are closed after 48-72 hours. The skills for suturing itself are quite simple – the knowledge to know when to and to NOT suture is not. – Flighter
JWR Replies: Suturing does have its purpose under some circumstances. I recommend that you stock up on suturing materials, as part of a comprehensive set of medical supplies for your retreat. OBTW, I recall that the folks at Ready Made Resources (one of our advertisers) has pre-loaded surgical staplers in sealed sterile packages (tres cool) available for sale.