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

  1. #11
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    Quote Originally Posted by Caduceus View Post
    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.
    Last edited by Hmac; 09-09-12 at 11:33.

  2. #12
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    Quote Originally Posted by Hmac View Post
    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.

  3. #13
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    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
    "In the end, it is not about the hardware, it's about the "software". Amateurs talk about hardware (equipment), professionals talk about software (training and mental readiness)" Lt. Col. Dave Grossman. On Combat

  4. #14
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    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.
    Last edited by mallowpufft; 09-09-12 at 22:49.

  5. #15
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    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.

  6. #16
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    Quote Originally Posted by rickp View Post
    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.

  7. #17
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    Quote Originally Posted by Hmac View Post
    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.
    Last edited by MedicPatriot; 09-10-12 at 14:20.

  8. #18
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    Quote Originally Posted by MedicPatriot View Post
    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.

  9. #19
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    Quote Originally Posted by jknopp44 View Post
    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.

  10. #20
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    Quote Originally Posted by Hmac View Post
    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.

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