View Full Version : Want Sutures? Bad Idea! (Wound Healing Without Sutures)
MedicPatriot
08-26-12, 18:37
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:
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 is completely gone. This is qouted from a zombiehunters.org discussion
"...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 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.
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.
skorcher247
09-08-12, 15:42
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.
Singlestack Wonder
09-08-12, 16:30
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.
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.
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.
ICANHITHIMMAN
09-09-12, 08:48
Will nursing students learn how to do this?
Will nursing students learn how to do this?
No. They will likely learn basic dressing change techniques and concepts, however, as well as basic wound evaluation.
.
Will nursing students learn how to do this?
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.
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.
RN's that scrub or even techs close skin fairly routinely in the OR, assuming there aren't medical students or residents around, but those skill aren't taught anywhere in nursing school..we actually have a formal training program to teach those OR personnel how to do that. And just as with RN's on the floor, there's no wound management decision-making that goes along.
We get nursing students coming through the OR all the time. I've never even seen one scrub. Usually they just sit in the corner of the OR and watch.
Dressing changes need to be done relative to the rate of accumulation of anything in the wound that can act as a bacterial substrate, whether it be serum, coagulum, pus, blood etc. Often, once a day will suffice. Sometimes, three times a day is necessary. Usually not more than that, but more often than not that's because of nursing time constraints rather than optimal wound management.
In an acute wound, frequent irrigation has no downside, especially within the lag phase (1-4 days). Those cells can't be washed away. The only thing that can be affected during that time period is fibrin deposition. Once neovascularization occurs, there's very little that can be done to the wound that will keep it from healing.
Suturing a wound is a minor technical skill that anyone can learn. The tricky part is knowing when not to suture a wound closed.
Completely agree; however, the challenge with teaching non-medical folks or survivalists/preppers/whatever is that they haven't a baseline on what a normal wound looks like or what the healing process is.
I learned in a 1-day class and through OJT, and if I can learn it anyone can (after all, it is a skill), but it isn't the magic bullet non-med folks thinks it is in regards to wound management.
This brings up a question for me. I'm not an EMT but have quite a bit of medical training starting in the military and later as a contractor we had very serious medical training every week for 2 sometimes 3 hours. The training was give by our 18Ds (SF medics). The idea was if our medic got hit, any of us could step in and stabilize the patient until we got to a safe area and could give the casualty to actual medical people. A lot of the stuff we dealt with were typical battlefield injuries. It also included simple stuff like IV's and more complicated stuff like creating an airway through the tracheotomies, dealing with Tension pneumothorax and the decomp. neddles, NPA, OPAs etc etc.....
So lets say we have to use hemostats, forceps, scissors, scalpels handles that have disposable scalpel blades etc etc... to do whatever the situation calls for, how can one re-sterilize that gear without having hospital facilities.
Can anyone elaborate on that?
Thanks
mallowpufft
09-09-12, 21:47
So I carry a suture kit in my MTB bag and hunting bag because I'm usually flying solo for those activities and if I think I need a suture to get home and to a doc then I will risk some minor infection to try my hand at it.
That being said I can attest to sutures bit being necessary IF YOU KEEP THE WOUND DAMN CLEAN.
Ten years ago I went into spetic shock and had the pleasure of recieving a full midline incision for the exploratory surgery.
I was given five staples and then two weeks later they were out and I had to do dressing g changes twice a day. The hole was so deep I could stick a sterile gloved finger in it and feel the stitches on my small intestine.
It took 5 months to fully heal with 2x daily dressing changes with 120cc per change saline flush. But it healed on its own. Except for the last bit the doc spread some silver nitrate on to cauterize the last half inch shut. Hurt like a mother. I've got a purty scar but it can be done. A couple other surgeons informed me that with a full suture or staple plus some drains it would have been healed up in 2-3 months.
Moral of the story, sutures are handy but as long as you can stop the bleeding and control infection you'll survive without them.
And as to sterilizing equipment as long as it is steel you can wash in soapy water then boil/steam it. An autoclave is just a fancy equipment steamer. Bleach water can also disinfect.
Tapatalk ate my spelling and grammar.
If this was mentioned previously then please disregard, but length of time the wound has been open is extremely important. Suturing wounds that have been open greater then 12 hours is very risky. Typically after 18 hours I would definitely not suture a wound closed.
This brings up a question for me. I'm not an EMT but have quite a bit of medical training starting in the military and later as a contractor we had very serious medical training every week for 2 sometimes 3 hours. The training was give by our 18Ds (SF medics). The idea was if our medic got hit, any of us could step in and stabilize the patient until we got to a safe area and could give the casualty to actual medical people. A lot of the stuff we dealt with were typical battlefield injuries. It also included simple stuff like IV's and more complicated stuff like creating an airway through the tracheotomies, dealing with Tension pneumothorax and the decomp. neddles, NPA, OPAs etc etc.....
So lets say we have to use hemostats, forceps, scissors, scalpels handles that have disposable scalpel blades etc etc... to do whatever the situation calls for, how can one re-sterilize that gear without having hospital facilities.
Can anyone elaborate on that?
Thanks
I'm not endorsing this ... but I've heard that in Bosnia (or Kosovo, or whatever regional flare it was I read about) they were using hydrogen peroxide.
Easiest/safest is boil them.
MedicPatriot
09-10-12, 13:17
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. Regardless, I probably never would do such a thing.
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.
I do know of at least two ER physicians who give some credit to the sugar packing being a legitimate treatment. I highly doubt I would ever use it, but they say it is not just a BS homeopathic treatment with no benefits.
I do know of at least two ER physicians who give some credit to the sugar packing being a legitimate treatment. I highly doubt I would ever use it, but they say it is not just a BS homeopathic treatment with no benefits.
Yikes. That's disturbing. I'm envisioning an ER doctor addressing a wound and packing it with sugar. Of course, they won't see that patient again...they'll be referred for followup to some other physician who will deal with the consequences.
In the absence of peer-reviewed literature endorsing the practice, that bit of deviation wouldn't fly in most ER's that I've ever seen.
If this was mentioned previously then please disregard, but length of time the wound has been open is extremely important. Suturing wounds that have been open greater then 12 hours is very risky. Typically after 18 hours I would definitely not suture a wound closed.
Delayed closure of a wound after 4-5 days is relatively common.
MedicPatriot
09-10-12, 14:11
Yikes. That's disturbing. I'm envisioning an ER doctor addressing a wound and packing it with sugar. Of course, they won't see that patient again...they'll be referred for followup to some other physician who will deal with the consequences.
In the absence of peer-reviewed literature endorsing the practice, that bit of deviation wouldn't fly in most ER's that I've ever seen.
Not in an ER, in a completely remote area. I too would be disturbed if I saw that in an ER. I'm not saying its a good idea at all, just throwing it out there that there are some qualified people who agree that it CAN work. Whether it is effective or appropriate is a whole different story.
Delayed closure of a wound after 4-5 days is relatively common.
You mean suturing a wound after being open 4-5 days is common?? Says who? If someone walks in off the street with a wound that has been open for the many days there is no way I would suture that closed. This is coming from an ER stand point. Post-op surgical situations are different.
I would also not put sugar in a wound.
You mean suturing a wound after being open 4-5 days is common?? Says who? If someone walks in off the street with a wound that has been open for the many days there is no way I would suture that closed. This is coming from an ER stand point. Post-op surgical situations are different.
I would also not put sugar in a wound.
Delayed closure of a clean, granulating wound is acceptable. Certainly that would likely be a planned event, which is where you're probably confused - a patient comes in with a grossly contaminated wound, you clean it out, debride it, then once it begins to granulate after about 4 days, he comes back and you close it. You're thinking of a patient wandering into the ER off the street with an open wound of indeterminate age. Yes, you're right. You wouldn't close that, you'd let it heal by secondary intention.
Delayed closure of a clean, granulating wound is acceptable. Certainly that would likely be a planned event, which is where you're probably confused - a patient comes in with a grossly contaminated wound, you clean it out, debride it, then once it begins to granulate after about 4 days, he comes back and you close it. You're thinking of a patient wandering into the ER off the street with an open wound of indeterminate age. Yes, you're right. You wouldn't close that, you'd let it heal by secondary intention.
I still have never seen that performed in an ER setting. Do you mean in a surgeons office? I cannot think of when I have ever seen this approach taken. Not trying to be argumentative just never seen that approach done. Have you? If so, I would be interested in the circumstances. There are indeed instances where if a physician is closely following the patient then delayed closure can take place but this HAS to be closely monitored. I am a Board Certified Emergency Room physician so I know a thing or two about wound care. ;)
We have to be careful about giving people the idea that if they keep a wound carefully cleaned they can close it at a later day several days down the road. Therefore I would say that it is NOT common at all to close wounds that have been open for several days.
mallowpufft
09-10-12, 18:52
I do know of at least two ER physicians who give some credit to the sugar packing being a legitimate treatment. I highly doubt I would ever use it, but they say it is not just a BS homeopathic treatment with no benefits.
Sugar has some minor natural anti bacterial properties which is why it is still used as a preservation aid; problem is that it kills good things too and isn't as effective as other options (like keeping it clean or visiting a MD). I wouldn't want it packed in a wound of mine other than as a last resort.
Tapatalk ate my spelling and grammar.
I still have never seen that performed in an ER setting. Do you mean in a surgeons office? I cannot think of when I have ever seen this approach taken. Not trying to be argumentative just never seen that approach done. Have you? If so, I would be interested in the circumstances. There are indeed instances where if a physician is closely following the patient then delayed closure can take place but this HAS to be closely monitored. I am a Board Certified Emergency Room physician so I know a thing or two about wound care. ;)
We have to be careful about giving people the idea that if they keep a wound carefully cleaned they can close it at a later day several days down the road. Therefore I would say that it is NOT common at all to close wounds that have been open for several days.
No, this wouldn't likely be something you would see in the ER. It would be a wound that you originally saw, then decided to either pack open, or called a surgeon to consult and he decided to pack open. Then return to the surgeon to either continue packing, or close if it was clean and granulating.
I acknowledge your expertise in dealing with acute wounds. As a General Surgeon, I'd be the guy you'd have those more complicated wound patients follow up with, or maybe the guy you'd call if the wound exceeded your training or experience, or needed to go to the OR for debridement and definitive management.
No, this wouldn't likely be something you would see in the ER. It would be a wound that you originally saw, then decided to either pack open, or called a surgeon to consult and he decided to pack open. Then return to the surgeon to either continue packing, or close if it was clean and granulating.
I acknowledge your expertise in dealing with acute wounds. As a General Surgeon, I'd be the guy you'd have those more complicated wound patients follow up with, or maybe the guy you'd call if the wound exceeded your training or experience, or needed to go to the OR for debridement and definitive management.
Ahh yes. My General Surgery collegues are the true experts at wound care. I have seen you all take care of some nasty chronic wounds with great outcomes. The problem I face is actually getting these people to follow up with you and keep their appointments.
Seconding the "delayed closure is done" comments. I'm more an ER background, but even as a med student I've seen some wounds up to several months of age closed up ... mainly big laparotomies that remained open and under a wound-vac. The wounds eventually healed by granulation enough to close. Obviously those were getting very close attention and were not a knee-jerk closure.
This is exactly how I was treated after my appendix operation. The wound healed from the inside out and took several weeks. The opening was 3-4 inches long, about a quarter inch wide, and deep enough to get to my appendix.
Apparent to me is a lack of clarity on why one would forgo usual medical protocols.. This discussion is clearly not intended for the present state of available medical care, nor the litigious environment of current US "medicine".
If in an austere environment, rapid definitive lasting treatment is needed. Facing extremely limited resources, minimal time with a medically trained person & likely won't have a chance to do a "follow up" in any method understood in a 1st world benign setting.. if at all.
Additionally, minimizing ones activities post tx is seldom an option in this. Clean, debride, prophylaxis(if available), seal wound, kick out the door.
SUTURES ARE GOOD.
if you don't understand anatomy deep layered sutures to the surface close may be a stretch. But it's certainly not rocket science. The body is amazingly resilient if you give it a chance.
I've trained and used illiterate medics to good effect. A literate educated person with the right guidance / books can do fine.
Based on couple decades+ of 3rd world experiences, in proximity to loud noises, with minimal resources.
Apparent to me is a lack of clarity on why one would forgo usual medical protocols.. This discussion is clearly not intended for the present state of available medical care, nor the litigious environment of current US "medicine".
If in an austere environment, rapid definitive lasting treatment is needed. Facing extremely limited resources, minimal time with a medically trained person & likely won't have a chance to do a "follow up" in any method understood in a 1st world benign setting.. if at all.
Additionally, minimizing ones activities post tx is seldom an option in this. Clean, debride, prophylaxis(if available), seal wound, kick out the door.
SUTURES ARE GOOD.
if you don't understand anatomy deep layered sutures to the surface close may be a stretch. But it's certainly not rocket science. The body is amazingly resilient if you give it a chance.
I've trained and used illiterate medics to good effect. A literate educated person with the right guidance / books can do fine.
Based on couple decades+ of 3rd world experiences, in proximity to loud noises, with minimal resources.
The reason as to how a given wound is managed depends on a variety of factors, including what caused the wound, under what circumstances, extent of tissue destruction, skill and/or knowledge of the person attending the wound, availability of resources during the management and afterward. No one-size-fits-all. Circumstances dictate the approach. The best one can hope for is someone attending the wound that understands the basic principles of evaluation and management.
Sutures are good in most circumstances for simple wounds. Sometimes they're not and the wound should be packed open. Those are "usual medical protocols" in the ER, the OR, or the zombie apocalypse, and even in an attack by a hoard of malpractice attorneys.
/
What about using maggots in a SHTF situation to debride a wound? Assuming you could get disease free larvae, would there be any advantages to cutting away tissue or just letting it heal on it's own? Is it necessary to debride wounds if there it's dead tissue present?
Thanks.
Yes, it's necessary to debride a wound of dead tissue.
Yes, maggots will do an excellent job of debriding a wound.
No, they won't necessarily do a better job than someone who has the proper tools and knows what they're doing.
Thanks HMAC and the others providing their expertise here. This is excellent information I think you would be hard pressed to find elsewhere.
Literature on use of Honey as anti-bacterial
---
A specific honey called Medihoney
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686636/
---
Natural honey antimicrobial effects
http://www.ncbi.nlm.nih.gov/pubmed/15298770
---
There are a lot more out there for specific ailments etc.
Honey is not homeopathic BS. (It is not even homeopathic, so saying it is just shows ignorance).
-
Literature on use of Honey as anti-bacterial
---
A specific honey called Medihoney
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686636/
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Natural honey antimicrobial effects
http://www.ncbi.nlm.nih.gov/pubmed/15298770
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There are a lot more out there for specific ailments etc.
Honey is not homeopathic BS. (It is not even homeopathic, so saying it is just shows ignorance).
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I don't mean to question your credentials as a medical professional. I know that Google has, in large part, replaced the need for doctors.
But yes...homeopathic bullshit. I'll be happy to refute further if you care to relate your experience with its use in a clinical setting, or if you could provide some evidence of your ability to parse the value or relevance of medical literature in the totality of literature available. Failing that, I'm not really inclined to argue about what you think you know about the practice of medicine.
I don't mean to question your credentials as a medical professional. I know that Google has, in large part, replaced the need for doctors.
But yes...homeopathic bullshit. I'll be happy to refute further if you care to relate your experience with its use in a clinical setting, or if you could provide some evidence of your ability to parse the value or relevance of medical literature in the totality of literature available. Failing that, I'm not really inclined to argue about what you think you know about the practice of medicine.
Well, you are just as ignorant as I am then, as it is not HOMEOPATHIC BS. Honey is not HOMEOPATHIC, therefore it cannot be HOMEOPATHIC BS. You may make the claim that the use of Honey as an anti-microbial in wound management is BS. You are welcome to your opinion. But you called Honey Homeopathic which is factually incorrect. (Btw, I don't practice homeopathy either and am not defending it here.)
I pointed out papers on the NIH website that dispute that and they include instances of Honey being used in a clinical setting (MediHoney -- Honey produced under exacting controls and setting and licensed for clinical use). But I'll defer to your all knowing presence and ignore the medical literature.
And for the record, I never claimed to be a medical professional nor did I claim Google made me one. Google only pointed to published papers on the NIH website, which you obviously did not even go read the extracts on, that disagree with your so-informed opinion. But I guess Google made you a homeopathic expert as well.
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Well, you are just as ignorant as I am then, as it is not HOMEOPATHIC BS. Honey is not HOMEOPATHIC, therefore it cannot be HOMEOPATHIC BS. You may make the claim that the use of Honey as an anti-microbial in wound management is BS. You are welcome to your opinion. But you called Honey Homeopathic which is factually incorrect. (Btw, I don't practice homeopathy either and am not defending it here.)
I pointed out papers on the NIH website that dispute that and they include instances of Honey being used in a clinical setting (MediHoney -- Honey produced under exacting controls and setting and licensed for clinical use). But I'll defer to your all knowing presence and ignore the medical literature.
And for the record, I never claimed to be a medical professional nor did I claim Google made me one. Google only pointed to published papers on the NIH website, which you obviously did not even go read the extracts on, that disagree with your so-informed opinion. But I guess Google made you a homeopathic expert as well.
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I have spent a lifetime creating wounds, fixing wounds, and treating wounds that other doctors don't have the expertise to fix themselves. To be labeled as ignorant about an area of the practice of medicine that I do every single working day of my life for 30 years by a..what?.. "cell phone app developer"? That goes beyond laughable. Try to stay in your lane. A Google search and review of any literature without any clinical expertise whatsoever makes you just look pathetic.
I have spent a lifetime creating wounds, fixing wounds, and treating wounds that other doctors don't have the expertise to fix themselves. To be labeled as ignorant about an area of the practice of medicine that I do every single working day of my life for 30 years by a..what?.. "cell phone app developer"? That goes beyond laughable. Try to stay in your lane. A Google search and review of any literature without any clinical expertise whatsoever makes you just look pathetic.
I did not call you ignorant in general. I said you were ignorant when it came to homeopathy, since you have repeatedly labeled honey as being "homeopathic BS" when it has nothing to do with "homeopathy." And since you have great disdain for homeopathy, I assume that your 30 years experience treating wounds has not included homeopathy, hence your statement above is superfluous. (And as I have noted, I am not a follower of homeopathy, and am somewhat of a sceptic on it).
Let's be clear:
1. I have not said that you should be using table honey or any honey clinically. (even the medihoney which is not approved in the US)
2. I pointed out that there is medical literature with regards to honey being used medically to treat certain kinds of conditions. Lots of it. There are also approved medical products based on honey in use in Australia and Germany, including in clinical settings. Your general POOH POOHing of honey as an anti microbial goes against medical literature -- note I did not look stuff up on eHow.com or Answers.com or anything -- I used abstracts of published medical literature listed on the NIH website. Hardly produced by ignoramuses. I have a science background and am capable of reading abstracts of papers and getting the general gist and a general understanding. I did not make any specific claims as to exactly what conditions and under what condition the use of honey is appropriate in anti-microbial applications. I only said that such applications exist, contrary to your exclamations (mostly in other threads, but also in this one). I would hope that you would pursue the literature as it pertains to honey used for anti-bacterial function in wound control. Some of the instances listed in its use in Germany were interesting (basically shutting down MRSA where a local antiseptic [octenidin] was ineffective). With all the concern about MRSA and the resistance it has and is continuing to develop against other medicines, honey may be an effective weapon.
Really, I would encourage you to read this and follow up with the footnotes and other references listed with it.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686636/
This is not homeopathic BS. It is an approved medical treatment used in clinical situations for wound care.
3. You have not shown ANY sort of evidence (published in the medical literature, or even your own research) that contradicts the use of honey (including medical grade honey) for certain sorts of would treatment. You have only put on your MD hat and said that only you are capable of understanding this and everyone else is ignorant and to leave it to the experts. While I respect your knowledge and experience as an MD, and are quite capable at what you do and within the boundaries of your knowledge and experience, an expert, I would guess that you have not read every journal that exists, nor are expert in every facet of medicine, and that others doctors and scientists might know something as well. Including those that have studied the use of honey and have approved it for medical use (in Europe and Australia, who are practitioners of modern medicine) and have written published papers on the subject.
4. I have made no claims for sugar. I could find no positive mention at all in literature and in fact noticed mention that certain tested bacterias were able to survive even with 100% glucose (though table sugar is mostly sucrose). However, sugar is also not homeopathic, so while it may be BS, it is not homeopathic BS.
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A) I keep a sports bottle in my larger aid kit in case I ever have to do irrigation away from running water- is that enough pressure?
B) Could you elaborate on the difference between clean and sterile water? I know that seems goofy, but what if you were in the field? Stream water filtered- that sterile enough? What about adding a few drops of betadine or bleach?
C) I imagine picking out obvious foreign material and trimming any obviously dead tissue away is a good idea (I have dissected many animals)
I never though of suturing as a serious option for the amateur... I'd rather be in a hovel for a month trying to keep a wound clean then going all Rambo with my fishing kit- so thanks for this info.
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.
Pilonidal Cyst? If so, I know you're situation.
Royalflush
12-04-12, 15:04
I'm not endorsing this ... but I've heard that in Bosnia (or Kosovo, or whatever regional flare it was I read about) they were using hydrogen peroxide.
Easiest/safest is boil them.
You can buy surgical scrub about anywhere- contains chlorhexadine. great for wound managment and also great for cleaning utensils in a pinch.
manual cleaning and then you can sterilize it in several fashions. Boil the utensils in water for 20 minutes will do it, if you had a pressure cooker it would do even better. the pressure cooker is an archaic method of autoclaving.
If you are in the field, you should still scrub biomaterials off the utensils and then you can soak in rubbing alcohol bath.
the old poor a "sip" of whiskey on the blade isn't exactly the gold standard.
In reference to the rest: suturing is easy once you get the hang of it. knowing when to suture and when not to suture is the hard part. you don't suture to "stop bleeding", you suture to re-unite an open wound that is already in the process of healing through 2nd intention healing.
I keep non absorbable suture in my FA kit as well as autoclaved needle holders, forceps, scissors and a scalpel. Suturing is rarely a "life saving" even when it comes to superficial wounds, but the wounds will heal a lot nicer and in most cases faster! (which is in disagreement with what someone above said). it's faster because the closer the 2 ends of tissue are together, the less granulation needs to occur to "bridge" the gap.
If done correctly it can prevent infection, but I've seen some HORRIBLE suturing on people and animals that was counter productive.
Will nursing students learn how to do this?
I just graduated from nursing school. I have packed pressure ulcers that you could fit your fist into on multiple occasions, so yes I'd say nursing students will learn a thing or two about wound healing. :)
ETA: To clarify I have not sutured anything. The extent to which we learned about would healing revolved around the concepts of keeping it clean and promoting formation of granulation tissue so that it can heal effectively.
Whoever posted about putting honey in wounds :nono:
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