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View Full Version : Staples & Surures - how to close wounds


hermosabeach
12-17-2012, 3:49 PM
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StratORcaster
12-17-2012, 3:52 PM
That will be fun without anesthesia. :D

hermosabeach
12-17-2012, 3:52 PM
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delta9
12-17-2012, 6:11 PM
Sometimes you will want to keep a wound open so it can drain

Librarian
12-17-2012, 6:32 PM
They do nice presentations - but in this arena, they have more to say -- http://www.doomandbloom.net/2011/05/to-stitch-or-not-to-stitch-that-is-the-question.html

So the big question is Ē to stitch or not to stitchĒ. After basic first aid is rendered, which includes removal of any foreign objects, homeostasis ( stopping the bleeding), irrigation, and antiseptic application, you will need to assess a few things to determine the answer.

First, determine if the wound still has any debris or dead-looking skin inside, if yes, do not close it with any materials ( including steri-strips). In other words, if itís dirty donít close it.

Along that same line of thinking is, if it is infected or even looks infected, donít close it. You will end up with a nasty infection.

Time is of the essence when it comes to making a decision about closing a wound. If the wound is over 6 hours old, leave it open. Bacteria is already multiplying inside and all you will end up doing is creating a worse infection to deal with. Irrigate (flush out) and debride ( use a gauze to vigorously rub inside the wound, think scrubbing) it really well. Place an antiseptic inside and outside of the wound and cover it up with sterile bandages and gauze. Change the dressing at least 3 times a day and monitor closely. Antibiotics may become necessary.

Size matters in this situation. If it is a large, gaping wound, do not close it. It would probably be impossible anyway, so donít even try. If you are able to approximate the edges easily and it is longer then 1/4 inch ,close it. If you see subcutaneous fat ( looks deep) close it, but only if it doesnít have any of the other factors for not closing ( over 6 hours, infected, dirty etc.).

Never close a wound that is dirty, infected or over 6 hours old. you need to be able to get into the wound and clean it frequently.

twinfin
12-17-2012, 6:38 PM
Good advice Librarian!

wjc
12-17-2012, 8:44 PM
I'd still like to learn how to do this...hands on.

Librarian
12-17-2012, 9:30 PM
I'd still like to learn how to do this...hands on.

Well, buy a pig's foot and a student suture kit (one example here (http://www.amazon.com/Training-Practicing-Stainless-Scissors-Hemostats/dp/B0060ZUU36/ref=pd_sbs_hpc_1)) and play. Can't hurt the pig any more ...

hermosabeach
12-18-2012, 12:03 AM
I purchased expired sutures for practicing as well

Foebia
12-18-2012, 2:03 AM
Dermabond, just glue it closed.

speedrrracer
12-18-2012, 6:11 AM
I'd still like to learn how to do this...hands on.

Go on a surf trip to Indo. Or, save some money and get the student suture kit w/pigs foot.

castgold
12-18-2012, 9:42 AM
I purchased expired sutures for practicing as well

If you practice with suture needle holders, get proper holders with a waffle pattern grip surface at the tips. Try to avoid cheap hemostats because the needle will turn and move while you are trying to send it through the flaps. It can be frustrating.

11HE9
12-18-2012, 7:38 PM
I have lots of practice with butterfly bandages :o

I'd still like to learn sutures though...

capnemo
12-18-2012, 8:08 PM
Get some surgical "Super Glue" for wound closures from a nurse or hospital friend. Much quicker and easier. Sutures are old school for the minor stuff. But the wound needs proper irrigation etc first of course...

Librarian
12-18-2012, 8:48 PM
Get some surgical "Super Glue" for wound closures from a nurse or hospital friend. Much quicker and easier. Sutures are old school for the minor stuff. But the wound needs proper irrigation etc first of course...

Trade name 'dermabond'. Lots available on Amazon (http://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=dermabond&sprefix=dermabon%2Caps&rh=i%3Aaps%2Ck%3Adermabond), as well as other places.

pwZc2Jjp94E

WZ596aIOVPc (Octylseal at Amazon (http://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=octylseal&sprefix=octyl%2Caps&rh=i%3Aaps%2Ck%3Aoctylseal))

12voltguy
12-18-2012, 9:38 PM
stapler

Saym14
12-18-2012, 9:40 PM
That will be fun without anesthesia. :D

stock up on booze

Spelunker
12-20-2012, 12:17 PM
sweet. Dermabond is getting added to my med kit

billmaykafer
12-20-2012, 12:52 PM
some of that fast clot stuff may be nice in your aid kit. and some moleskin too.

speedrrracer
12-20-2012, 3:36 PM
Get some surgical "Super Glue" for wound closures from a nurse or hospital friend. Much quicker and easier. Sutures are old school for the minor stuff. But the wound needs proper irrigation etc first of course...

Not so sure about that. Dermabond's own website says that if deep dermal stitches are required, there is no substitute for stiches:

...DERMABOND adhesive may be used in conjunction with, but not in place of, deep dermal stitches.

DERMABOND adhesive does not replace subcutaneous stitches, if they are required. DERMABOND adhesive can be used when there is minimal to no tension on the wound and it has easily approximated edges.

http://www.closuremed.com/faqs_medprof.htm

Sounds to me like Dermabond is for the minor stuff.

ElvenSoul
12-20-2012, 6:10 PM
I have slapped moleslskin on lots of cuts and blisters.

wjc
12-20-2012, 8:19 PM
Well, buy a pig's foot and a student suture kit (one example here (http://www.amazon.com/Training-Practicing-Stainless-Scissors-Hemostats/dp/B0060ZUU36/ref=pd_sbs_hpc_1)) and play. Can't hurt the pig any more ...

I already have a surgical kit. I'd like to get some instruction.

I'm an engineer and I always question procedures so someone to answer questions would be helpful.

JMP
12-25-2012, 1:41 AM
In SHTF, you use sterile strips if possible. If the would is too large, you cauterize. That's all there is too it.

Fjold
12-25-2012, 7:35 AM
http://img.photobucket.com/albums/v214/Fjold/KneeStaples.jpg

44fred
12-25-2012, 10:42 AM
http://img.photobucket.com/albums/v214/Fjold/KneeStaples.jpg


Cool. Knee replacement?

wheels
12-25-2012, 1:39 PM
sweet. Dermabond is getting added to my med kit

May want to check out vetbond - 3ml of vetbond is 50% less than .7ml of dermabond. I'm just a big dumb animal anyway.

Librarian
12-25-2012, 1:59 PM
http://img.photobucket.com/albums/v214/Fjold/KneeStaples.jpg

Staple-gun accident?

Actually, that's a nice neat job.

Best I've seen was scalp stapling after brain surgery.

BruceR
12-25-2012, 2:01 PM
I cut my thumb fairly deep with a box-cutter type knife, right down to the bone. I flushed the wound with cold water for 10-15 minutes until the wound clotted but it still needed mending. I sent my daughter to buy some superglue, my usual remedy of choice. She brought back the gel form but I used it anyway. It worked great. Like working with honey, I dabbed it on each side wound in little dots, zig-zagging back and forth across the cut as I moved along. The honey-like strings connected each dot to its neighber across the cut, forming stitches that held after a short cure time. These ersatz stitches held quite well for a few days and only came off at the glue/skin bonding site. Recommended highly.

Librarian
12-25-2012, 2:46 PM
Couple of drawbacks to super glue - see http://www.survivalistboards.com/showthread.php?t=95194, http://www.aafp.org/afp/2000/0301/p1383.html, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214492/, http://emedicine.medscape.com/article/874047-overview, http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/The-Latest-Choice-in-Wound-Closure.aspx

Vet-Bond is cheaper than dermabond, as noted ... http://www.amazon.com/3M-70200742529-Vetbond-Adhesive-3ml/dp/B004C12Q46

OHOD
12-25-2012, 3:02 PM
Last summer, I was hiking out at Stanislaus NF. I was using a blade to cut open a tied down package and having trouble with it. For all the things I could do, I just could not get my blade in the right position.

After a few minutes, I figured, hmmm If I hold the tie in this position with my other hand, then I can cut the tie. :D

I tried it! Voila! I cut the tie!

Sadly, I underestimated how much tension was on the tie and my knifed hand bolted away from the tie in an awkward direction and cut underneath my wrist.

To this day, I have not been able to position my hands in such a way that I could replicate how it happened. :shrug: The whole situation has been a mystery to this day.

Anyway, as soon as the cut happened...I cussed, said ouch and then looked at the wound. Deep big time. The cut was bleeding like an open spichot. Rather than put a bandage on right away, I allowed the wound to bleed for a while and kept my wrist BELOW my heart. I know, keep it above. But my point was to make it bleed. I got my first aid kit.

Cleansed the wound with saline :shifty:. And used an iodine swab to cleanse around the wound and inside the periphery. After I was sure the wound was free of bacteria, at least as much as I could, then I closed the wound with steri-strips and covered with gauze and Coban.

It took weeks for the wound to finally close appropriately, so that would indicate that I needed stitches. Fortunately for me, I have impeccable wound care skills. :D

To this day, I feel the tendon in my wrist spasm. So, I probably nicked the tendon as well.

Super cool scar though. ;)

Librarian
12-25-2012, 6:45 PM
Last summer, I was hiking out at Stanislaus NF. I was using a blade to cut open a tied down package and having trouble with it. For all the things I could do, I just could not get my blade in the right position.

After a few minutes, I figured, hmmm If I hold the tie in this position with my other hand, then I can cut the tie. :D

I tried it! Voila! I cut the tie!

Sadly, I underestimated how much tension was on the tie and my knifed hand bolted away from the tie in an awkward direction and cut underneath my wrist.

To this day, I have not been able to position my hands in such a way that I could replicate how it happened. :shrug: The whole situation has been a mystery to this day.

Anyway, as soon as the cut happened...I cussed, said ouch and then looked at the wound. Deep big time. The cut was bleeding like an open spichot. Rather than put a bandage on right away, I allowed the wound to bleed for a while and kept my wrist BELOW my heart. I know, keep it above. But my point was to make it bleed. I got my first aid kit.

Cleansed the wound with saline :shifty:. And used an iodine swab to cleanse around the wound and inside the periphery. After I was sure the wound was free of bacteria, at least as much as I could, then I closed the wound with steri-strips and covered with gauze and Coban.

It took weeks for the wound to finally close appropriately, so that would indicate that I needed stitches. Fortunately for me, I have impeccable wound care skills. :D

To this day, I feel the tendon in my wrist spasm. So, I probably nicked the tendon as well.

Super cool scar though. ;)

And now you carry scissors as well as a knife, right?

Fjold
12-25-2012, 7:40 PM
Staple-gun accident?

Actually, that's a nice neat job.

Best I've seen was scalp stapling after brain surgery.

They heal up fine, here's the other side of the same knee:

http://img.photobucket.com/albums/v214/Fjold/Kneeoutside.jpg