To Stitch or Not to Stitch, THAT is the Question!!
Treating a Laceration in a Collapse Situation
There may come a time that you are faced with treating a laceration in a collapse situation. Our lives will be filled with tasks and chores we may have never, or rarely, performed such as chopping wood. The big question will be, “To stitch or not to stitch” the wound or laceration.
There are several closure materials available to close a wound or laceration. The simplest and least invasive ( does not puncture the skin) are steri-strips and butterfly closures. They are sterile, sticky strips which are easily used to pull the wound together. They will naturally fall off after a few days and do not need to be replaced.
The second least invasive method is “medical glue”, commonly called derma-bond. This is a medical grade glue made specifically for use on the skin. Superglue will cause a heat reaction and is not made for use on the skin, however, IF you have nothing else ( didn’t I tell you to stockpile a medical kit..lol) do what you have to. Hold the skin approximated ( just touching side to side) and run a thin line down the “seam”. It will naturally peel off as the skin heals.
The next closure material is skin staples, not paper staples! Please don’t use that paper stapler, not ever. They work by “pinching” the skin together and should be removed in about 5-7 days. This may cause some discomfort as the skin may have healed over the staples a bit.
Sutures are your most invasive method of wound or laceration closure. If you cannot numb the skin first these are going to hurt a lot. At least put some ice on the area to be sutured for a few minutes, not too long as you don’t want to cause more damage to the area. Then begin at one end and close the wound with any of several techniques you can find on You Tube.
Closing a Wound: To Stitch or Not to Stitch
So the big question is ” to stitch of not to stitch”. 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 it’s dirty don’t close it. Along that same line of thinking is, if it is infected or even looks infected, don’t 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 don’t 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 doesn’t 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.
Always use the least invasive method for closing a wound. Just because you know how to suture doesn’t mean you should be suturing! Ask yourself if the steri-strips or butterfly closures might do just fine. How about the medical glue? Not puncturing the skin is always best. Every time you enter the skin you are introducing more bacteria the body has to deal with. Don’t ever do more then you have to. Keep it simple.
Learning what to do in these circumstances is imperative for anyone who plans on being responsible for the medical well-being of their survival community. Have the right training and supplies and you will be successful.
Please check out our Youtube channel, soon Dr Bones will have a suturing how-to video! In the mean time you can see Nurse Amy’s container garden videos! Here’s the link;