Want Sutures? Bad Idea! (Wound Healing Without Sutures)

I wrote this for a local shooting forum, but I figured it would be a good thing to post here.

I really have to say this because it is bothering me. A lot of 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.



Continue reading if you care to learn what to do without sutures



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 talking to a physician who is into this SHTF stuff I finally have 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 you 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:

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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).

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I will also mention that there are some wounds in which the layer of skin is completely gone. This is qouted from a zombiehunters.org discussion

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"...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!

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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 made 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. 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.

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

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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.

All very interesting things to think about. It's amazing how complicated little things like a common laceration on an extremity or an avulsion on the shin can be without a higher level of medical care. Makes me think about reevaluating my med bag.

I understand the importance of a lot of treatments described being a hospital corpsman in the Navy. One wound can deplete your med supplies in the zombie apocalypse or a SHTF situation and one emergency medicine book in your bag is invaluable as well as someone trained on what to do in situations like these.

Thanks for the informative post!

If you don't mind me adding some thoughts:
- if you pack a wound with gauze, keep count of the number you put in. You want to be sure to pull the same number OUT.
- if you end up packing a wound, it can be fairly loose. You don't have to cram in every piece of gauze in the planet. The idea is to keep the wound edges apart, not stuff a chicken. Opening up your 2x2 or 4x4 piece of gauze gets you a pretty large piece of loose gauze, which can be inserted into the wound.
- leave a little bit of gauze sticking out of the wound. This will keep the surface open, as well as help remove it later.
- if you do have to start cutting out dead tissue ... well, I hope you know what you're doing ... but dead tissue doesn't hurt. Cut away. Stop when it hurts, you started getting to live tissue. It'll also start bleeding.

While my own personal medical knowledge is next to nonexistent, I do have some first hand experience with dealing with a deep wound. I had a roughly 1 inch long and 1 inch deep incision into my right butt cheek as the result of an abscess. My treatment involved flushing it at least 3 times a day, as well as after bowel movements and not counting showering, with roughly 3 liters of warm clean water and then dressing the wound with sterile gauze, but not packing it. The wound took about a month to heal while I'm not sure how bad the scar is, I can feel it, none of the women I've been with have complained about it being huge or ugly.

No pain killers or antibiotics. I had both after the first surgery that removed the abscess, but none after the second one that basically just removed the drainage tube and prepped the site for good healing, not to sure, its been a few years.

Thank you for posting this. I did a lot of suturing in the mil, and today when I teach medical classes a lot of people, almost always novices, want to know how to suture. I have to spend 15 minutes on telling them why it's a bad idea and why I won't teach it, and they seem to get a little bummed.

As my old professor used to say, "it's the natural tendency of all wounds to heal". There isn't anything that any of us can do to make that occur any faster, the best we can do is diligently attend the wound to eliminate factors that can make it heal slower. Wash it out (soap and water is as good as anything), cut away any non-viable tissue that occurs from the wound mechanism and continue to debride any dead tissue that shows up in succeeding days in order to eliminate a substrate for bacterial overgrowth and invasion. Best way to do that is one, two, or three-times-a-day dressing changes with dry gauze.

Suturing a wound is a minor technical skill that anyone can learn. The tricky part is knowing when not to suture a wound closed. If one's medical knowledge is insufficient for that evaluation to be completely clear, the best thing to do is just wash it out, pack it with dry gauze, wrap it up, and change the dressings once or twice a day.

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Originally Posted by MedicPatriot

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.

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Sorry, I think this it total homeopathic baloney with negligible scientific merit. The table condiments used in the scenario you propose will do nothing. The act of washing the wound out, irrigating, and reapplying the dressings "numerous times a day" is extremely beneficial and an absolute key component of wound care. What we're talking about here is prevention of any local infection. Even if one believes that honey by itself has some bacteriostatic properties, the key to preventing local bacterial invasion of the wound remains washing and debridement. As for a "sugar/betadine" nostrum, the betadine does the work. You could skip the granulated sugar, and should.

Antibiotics? There is merit in giving an up-front dose of an appropriate antibiotic as prophylaxis. Beyond 24 hours, the local wound inflammatory response and the resultant induration will impair significant levels of the antibiotic in the wound itself and likely have little, if any, value. The place for antibiotics after a prophylactic dose is if and when the patient shows signs of a systemic infection as a result of wound infection. If they aren't febrile and don't show redness and induration extending beyond the wound (what your mammy used to call "blood poisoning"), local attention to the wound itself remains the important point.

Will nursing students learn how to do this?

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Originally Posted by ICANHITHIMMAN

Will nursing students learn how to do this?

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No. They will likely learn basic dressing change techniques and concepts, however, as well as basic wound evaluation.

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Originally Posted by ICANHITHIMMAN

Will nursing students learn how to do this?

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Ditto Hmac.

I mean, you'll eventually 'learn' how to suture if you pay attention enough - it's not really a difficult skill to do simple interrupted skin sutures. It's more complex if you talk layered sutures, horizontal and vertical mattress sutures, etc. Plus, which suture material to use.

If you're an OR nurse you MIGHT get to help suture on occasion, especially if you work with the same surgeons for a while, or if they're really busy.

As for washing wounds multiple times a day, I'd actually advise against it. You want it clean, but you don't want to interrupt the natural healing. If you're flushing the thing every 10 minutes, you start rinsing out the cells that are trying to grow back. In my experience, we do daily dressing changes. This covers outpatient and inpatient environments. If you're worried about cosmetic effects, you could argue for more frequent changes, but typically those have been closed already.

And finally, gauze just sometimes doesn't cut it. There's a reason that specialty bandages are made - alganate, silver-impregnated, etc.