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» A Well Regulated Militia » Basic Training » Field Medicine » Sutures & Wound Healing

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Author Topic: Sutures & Wound Healing
OLM-Medic
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This is an essay I wrote on the local survival forum in regards to suturing. I really wanted to address the people who carry sutures and don't know anything about them. Not only must I give the quotes in this essay the proper credit, but also all of the knowledge I have gained is merely a reiteration of Flight-ER-Doc in my own words. Credit must be given there. Anyways I figured I would share it here. Here it is:

Many well meaning preppers ask me about sutures, or have sutures in their kit.

DO NOT suture anything unless you REALLY know what you're doing. It isn't as simple as just sewing the ends together. You need to be trained in properly debriding wounds (including cutting out dead muscle tissue, etc). Not to mention, you also have to know the different layers of tissue to be sutured. You risk killing the person by sealing in all infectious material and debris.

So you are probably thinking, "this wound will never heal without stitches" right? That isn't true. A lot of suturing is for cosmetic reasons (to reduce scarring) and to obviously keep the flesh together for functionality and quicker healing. Even very deep wounds can heal without sutures, but they will taking much much longer and probably have very ugly scarring. On the other hand, you will not be "sealing in" unwanted debris and you will be allowing the wound to drain properly.

So please, do not suture or attempt suturing if the SHTF because "you have to." You don't, and the risk it too great.

So now that you know that sutures aren't completely necessary, you are probably wondering what you're supposed to do. It took me a while to realize this, but after doing much research and talking to a physician who is into this SHTF stuff I finally have [some of] it down.

For one thing the wound must be irrigated (with copious amounts of sterile or clean water if sterile isn't available). At the end of the irrigation process, something to get the pressure of the irrigation up would be beneficial as well. By this I mean if you have access to IV equipment, then use a 20gauge catheter, that way you can "pressure wash" the wound. After the irrigation, one thing we are missing out on is wound debriding (cutting away the dead skin around the holes, and the dead muscle inside). I don't know how to do this properly, and I assume you don't either. I will just leave it at that.

If the wound really isn't that bad, but its one of those that someone would say "oh you need stitches to close that up" then you probably can get away with irrigating it and keeping it clean every day. It should heal on its own in time.

As for the deeper wounds, its a bit different. Now after you have your wound irrigated with a shitload of fluid (which is proper medical terminology for "several liters" in case you didn't know), you will pack it with sterile (or aseptic/clean if its all you have) kerlix (stretch gauze rolls) or gauze. This will allow it to drain by keeping it open. You must change these atleast 2 times a day bare minimum and irrigate before putting in new packing.

Now you ask "well with all of that junk in there how will the wound ever close?" Don't worry, this boggled my mind at first too. Eventually you should be able to pack less and less in the wound, over time of course. It will heal from the bottom up, so to speak. One thing you have to watch out for is premature closing of the top layers of tissue. The healing from the bottom up MUST happen this way, and if the top layers were to close prematurely, you will be setting up for an anaerobic infection that will probably result in death in SHTF conditons. So, now you can see why just suturing the top flaps of skin together in a deep wound could be lethal. It's the same concept. What about the dead muscle tissue that needs to be cut out? I honestly don't have an answer for you on that yet, because I simply don't know how to do it.

To qoute the physician who has helped me on these topics:

quote:
Things to watch out for would be early closure of the skin before the underlying tissue was free of infection - that would cause an anerobic infection which would probably be fatal, absent an amputation (think Gangrene).
I will also mention that there are some wounds in which the layer of skin of completely gone. This is qouted from a zombiehunters.org discussion by a member whose username I can't remember
quote:

"...just sharp and jagged enough to shave all the skin and flesh off of your left shin. Right down to the bone. The meat that was formerly known as your shin (now known by the symbol ) is now dangling from the rock, completely detached from your leg, looking like a flesh colored and slightly bloody chamois cloth.
Talk about SHAM-WOW!

The idea is that it will heal inwards like any other wound. You must irrigate regularly, but not forcefully enough to disrupt the new growing skin cells. Keep it covered. Healing will take a long time for this one. What you don't want to do is try to pull the skin tight together and suture it, or try to reattach the dead skin.

Now that we're taking care of this wound and the SHTF, we are on our own. Many people are really into antibiotics in this community, but I must caution you on one thing: learn about them. Each antibiotic is make for a specific duty, and you can't just give any old antibiotic and expect results. What was recommended to me for a severe wound like this (it was actually a GSW to the leg...which was mutilated) was hopefully something that is a broad spectrum antibiotic, like moxifloxacin (Avelox). Failing that, he recommends Azithromycin (ZPack) and Septra DS (Trimethoprim/Sulfamethoxazole Double strength) also known as Bactrim. He emphasizes that antibiotics really depend on many things, such as the suspected type of organism and what is usual in your area. Due the complications of understanding antibiotics, I will not go on about the treatment of them. You must learn about these on your own. Even I don't TRULY know what I'm doing with them, and must continue learning. One thing I will say is keep your expired pills. They are most likely good long after the expiration date.

Some people mention honey or sugar for fighting infections, and it really is a legitimate treatment for local infections. I believe the proper treatment with sugar is to pack the infected wound with granulated sugar mixed with Betadine to form a thick paste. Sugardyne was a commercial product of this that no longer exists (unless they started making it again). The concoction. must be washed out numerous times a day, irrigated, and reapplied again. It will also be drawing moisture from the patient, so hydration is important. There are other ways to do this, do the research yourself.

As far as healing goes, it depends on the wound and if it gets infected or not. For really nasty ones it could be up to 2-3 months. TO quote the physician once again:
quote:

A lot would depend on avoiding infection (strict hygiene, frequent dressing changes) and the patients nutritional status (especially zinc, copper, protein, and vitamin C).

Now imagine changing dressings multiples times a day for that long of a time period. You better reevaluate your gauze and kerlix supply.

Other complications need to be thought about. What if the injury was a GSW which shattered a bone in the extremity? There may be nothing you can do to save this person. Depending on the injury, the bone may lose blood supply and cause necrosis of the leg. Ready to pull out the hacksaw and amputate? You are likely to kill them. It is much more complicated then just hacking off a limb. What to do? I don't know...you better hope there is some way to get to a hospital.

So I hope you thought this was worth reading and have learned a thing or two. Just remember that some things you just can't fix and we will have to hope that a medical infrastructures still exist post-SHTF for certain things.

[ 02-02-2012, 10:32 PM: Message edited by: OLM-Medic ]

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"Remember that your adversary's desire to live is usually more powerful than whatever ammunition your are carrying in your firearms. Plan accordingly." -tire iron

Posts: 731 | From: Maryland | Registered: Aug 2009  | Report this post to a Moderator
mak9030mag
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Thanks for posting will keep info in mind. Thanks again.

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Mak

Posts: 936 | From: washington | Registered: Sep 2006  | Report this post to a Moderator
mak9030mag
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OLD medic do you mind if I cut and paste your info and put on other web sites?

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Mak

Posts: 936 | From: washington | Registered: Sep 2006  | Report this post to a Moderator
OLM-Medic
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No I don't mind but give the same credit as I did.

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"Remember that your adversary's desire to live is usually more powerful than whatever ammunition your are carrying in your firearms. Plan accordingly." -tire iron

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Flight-ER-Doc
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Good advice from OLM-Medic.

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Emergency Medicine - saving the world from themselves, one at a time.

"Thou shalt not be a victim, thou shalt not be a perpetrator, but, above all, thou shalt not be a bystander."

I make the ADL soil themselves. And that makes me very happy :)

Posts: 1903 | From: Slipping the surly bonds of earth | Registered: Dec 2004  | Report this post to a Moderator
Breacher
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Man, i thought as long as you keep the thread in your knife handle fishing and sewing kit clean you are good to go. It worked for Sly Stallone when they ran over budget on the first Rambo movie and could not afford to use fake makeup blood...

I mean you can tell his was not cut from falling through jagged tree limbs, it was too clean...he just did the cut with the knife before the camera was rolling...

In all honesty, I think I have some suture kits with my medical gear but was just holding that as part of my SHTF clinic supplies, where part of the SHTF plan is to find a qualified medical person. The last time I got stitches it was done at a regular clinic but I still have a scar. Not a really bad one, just enough for some tough guy stories. Prison knife fight, schrapnel from Afghanistan, or well, I got clocked in the face by a hand truck handle when a load shifted in a recycle dumpster...

I was under the impression though you want to get everything cleaned and stitched as quickly as possible while the injury is fresh and numb, because it will soon be hurting like hell, and once the hurt sets in, stitching gets painful and difficult.

What is your opinion on body staplers? I actually have one somewhere, never used it, never trained to use it. I just had this goal of spending as much on medical supplies as I would spend on a rifle so I had that put in one of the clinic bags with a supply of staples. I thought it would be covered in a combat first responder course I took but they never brought it up either. I know civilian paramedics use them to some degree on very large cuts.

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Life liberty, and the pursuit of those who threaten them.

Trump: not the president America needs, but the president America deserves.

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Texas Resistance
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The choices aren't just leave the wound wide open to drain or stitch it clear shut. You could stitch it mostly closed and leave one end open some to drain or sew in a piece of surgical rubber tubing to let it drain for a few days then remove the drain tube and stitch it shut the rest of the way.

I have a friend who uses a surgical stapler on his hog hunting dogs when they get ripped open by a wild boar's tusks. If it was sterile you could staple a person with one too.

During the middle ages women did the suturing with regular sewing thread and needle. During the civil war the Confederate Doctors sutured with horse tail hair.

[ 02-03-2012, 09:12 PM: Message edited by: Texas Resistance ]

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www.TexasMilitia.Info “Seek out and join a lawful Militia or form one in your area. If you wish to remain Free you will have to fight for it...because the traitors will give us no choice in the matter” William Cooper

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Flight-ER-Doc
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quote:
Originally posted by Texas Resistance:
The choices aren't just leave the wound wide open to drain or stitch it clear shut. You could stitch it mostly closed and leave one end open some to drain or sew in a piece of surgical rubber tubing to let it drain for a few days then remove the drain tube and stitch it shut the rest of the way.

I have a friend who uses a surgical stapler on his hog hunting dogs when they get ripped open by a wild boar's tusks. If it was sterile you could staple a person with one too.

During the middle ages women did the suturing with regular sewing thread and needle. During the civil war the Confederate Doctors sutured with horse tail hair.

If you can't clean the wound out, putting in a drain doesn't matter - in fact, if you can't clean it out you can't be sure the drain is sterile, either.

And those sutures using womans, or horse hair, or linen or silk thread? They were one of the primary reasons that wounds of the era were so deadly: They caused infections themselves.

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Emergency Medicine - saving the world from themselves, one at a time.

"Thou shalt not be a victim, thou shalt not be a perpetrator, but, above all, thou shalt not be a bystander."

I make the ADL soil themselves. And that makes me very happy :)

Posts: 1903 | From: Slipping the surly bonds of earth | Registered: Dec 2004  | Report this post to a Moderator
Leo
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Honey!

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Fight the fight, Endure to win!

Posts: 968 | From: A 127 Btn 10 FF | Registered: Aug 2009  | Report this post to a Moderator
ConSigCor
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During the uncivil war, silk thread was "standard issue" for the medical profession. But it was in extremely short supply in the South so they experimented with various alternatives. The Director of the Medical Dept., Army Of Tenn. discovered that the infection rate dropped dramatically when they used horse hair that had been boiled to soften it up so they could sew with it. Although they didn't understand much about germs they came to realize their was a correlation between cleanliness and a lowered infection rate. So, he issued a mandatory order that all AOT hospitals be kept clean and even promoted the idea of boiling surgical instruments before each use. Some of the older doctors thought he was nuts.
Posts: 14806 | From: A 059 Btn 16 FF MSC | Registered: Oct 2001  | Report this post to a Moderator
skyvalleysquirrel50
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Great post!

1 thing I did notice is: Do not keep tetracycline after its expiration date. If I remember correctly Tetracycline's become toxic after their expiration.

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Those who say "violence never solves anything" have never experienced violence.

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Mexneck
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Giving this a bump as Flight ER Doc referenced it in a response to another post I made.

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Well, this is it.

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Flight-ER-Doc
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quote:
Originally posted by skyvalleysquirrel50:
Great post!

1 thing I did notice is: Do not keep tetracycline after its expiration date. If I remember correctly Tetracycline's become toxic after their expiration.

Yeah, not something I worry about.

That particular rumor got started when Tet was new, and one patient had some kidney difficulties after taking some expired tet....and a physician wrote it up as a case report.

The manufacturer got all concerned, thought it might (possibly, but only one case so who knows) be the ascorbic acid (vitamin-C) used to adjust the pH of the tablets, and changed it.

50 years later, the rumor persists.

The only thing to be careful of with tet is giving it to pregnant women..it discolors teeth in the unborn

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Emergency Medicine - saving the world from themselves, one at a time.

"Thou shalt not be a victim, thou shalt not be a perpetrator, but, above all, thou shalt not be a bystander."

I make the ADL soil themselves. And that makes me very happy :)

Posts: 1903 | From: Slipping the surly bonds of earth | Registered: Dec 2004  | Report this post to a Moderator
ConSigCor
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When I was a kid back in the early 60's the Dr pumped me full of Tet...turned my teeth a nice shade of obummer brown.

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"The time for war has not yet come, but it will come and that soon, and when it does come, my advice is to draw the sword and throw away the scabbard." Gen. T.J. Jackson, March 1861

Posts: 14806 | From: A 059 Btn 16 FF MSC | Registered: Oct 2001  | Report this post to a Moderator
State Commander-California
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yep I have to agree on some of the comments
do not practice some of this unless you have the proper training .
I have a little story to tell. One year I was sent up north from where I am to full fill a contract as a contract EMT . During the event we had a individual that fell down or was hit by a vehicle sustaining a head injury. When both my partner were arriving I observed coming to the scene, an individual dragging subject out of the bushes by the person ankles and heels I'm thinking "what the fuck are you doing "?
Wow I never saw someone do that before turns out the idiot was an off duty EMT. We documented the shit out of the event, to protect our
licence's .The police had also responded to see if they could help. Needless to say the so called off duty EMT didn't wait around to answer questions. In all my years I will never forget that incident I mean where did that person go to EMT school? complete violation of C spine 101,let alone cause additional injuries. I literally saw the persons head bump off the curb and onto the sidewalk. I say it again what the fuck .

[ 07-19-2017, 04:46 PM: Message edited by: State Commander-California ]

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