NOTE: Shanethenurse is a gen­tle­man I con­sid­er a friend, is a prep­per, and some­one I met on Face­book of all places well over a year ago.  We con­tin­ue to be in touch, chat from time to time, and he offered a few posts around first aid, med­i­cine, etc. since this is an area I am lack­ing on the site.  Shane, I appre­ci­ate the effort, and thank you VERY MUCH.  —

Assort­ed Wound Sup­plies, click to see a larg­er image

You are out in the woods one day split­ting fire wood and you miss the log and con­nect with your leg instead cut­ting a deep gash. Unfor­tu­nate­ly you are miles from nowhere and there is nobody that can help you. What do you do?

If you are pre­pared you can take care of that wound prop­er­ly and be well on your way to a full recov­ery.

First you need to con­trol the bleed­ing with direct and con­stant pres­sure until the bleed­ing has stopped. Do not use a tourni­quet.

After the bleed­ing has stopped was out the wound with water until it is clean and any debris has been removed. Now cleanse the wound and sur­round­ing area with Provi­done Iodine which is avail­able at most phar­ma­cies rel­a­tive­ly cheap­ly. Flush the wound with water again, not creek water, nice clean, microbe free water from an unopened bot­tle if pos­si­ble.

Once the wound has been cleaned assess the dam­age, how deep it is, how wide it gapes. If it can be closed with an adhe­sive wound clo­sure strips, aka steri strips, or by using the skin clo­sure glue cyano­acry­late (Der­mabond, Krazy Glue) then do so.

Click to see larg­er image

When using the glue and strip method this is how I do it in the ER. Bring the wound edges togeth­er and apply the glue, some peo­ple put the glue in the wound but I do not. While the glue is still tacky apply the adhe­sive strip to rein­force the glue and main­tain the clo­sure. Once the glue has dried apply a gauze dress­ing and since we are talk­ing about a low­er leg wound apply an elas­tic ban­dage, ACE wrap, to keep pres­sure on the wound and decrease swelling.  Glue and strip is my pre­ferred method for wounds of the face when at all pos­si­ble.

If the wound is deep­er and needs a few stitch­es, the steps are very sim­i­lar. Break out the instru­ments; 2 for­ceps, scis­sors, and the suture of an appro­pri­ate size. When it comes to suture mate­r­i­al, the big­ger the num­ber the small­er the diam­e­ter of the line.  Suture mate­r­i­al is gen­er­al­ly avail­able at any place that sells farm or vet­eri­nary sup­plies, such as Trac­tor Sup­ply Com­pa­ny.

To begin place the nee­dle in the jaws of one of the for­ceps, ster­il­ized nee­dle nose pli­er will work if you have noth­ing else. Hold the wound togeth­er as best you can, this is where a helper would be great or you could use an adhe­sive strip to keep it togeth­er while you sew. In the ER I would most like­ly inject Lido­caine into the sur­round­ing tis­sues to decrease the pain of the nee­dle inser­tion. It is very unlike­ly Lido­caine will be avail­able for this sit­u­a­tion. The idea with sutur­ing is to bring the wound edges togeth­er. Some­times this is not pos­si­ble due to tis­sue loss or the shape of the wound. So try and get the edges as close to nor­mal as pos­si­ble with­out pulling them too tight. Some peo­ple say to start at the mid­dle, some at one or the oth­er. It does not real­ly mat­ter where you start so long as to wound is closed prop­er­ly and some­what resem­bles what it looked like before the wound. Since we are using the adhe­sive strips to keep the edges togeth­er this will be a breeze.

Take the for­cep with the nee­dle and insert the nee­dle 2–4mm from the edge of the wound and dri­ve it down about 25% of the length of the nee­dle before start­ing to curve it back up the oth­er side. Pull it through until there is around 4 inch­es of line left, at this point you will tie the knot. We gen­er­al­ly use a square knot which may need to be repeat­ed up to 7 times depend­ing on the suture mate­r­i­al used, because you do not want all that hard work to come undone. Cut the line leav­ing around 1/2inch on each tail. Repeat until the wound is com­plete­ly sutured. Once the sutur­ing is done apply an antibi­ot­ic oint­ment topped with a gauze and then wrapped with a ten­sion ban­dage. Give it a week and then remove the sutures.

If the wound is very deep then a Mat­tress Stitch may be need­ed. To do this you insert the nee­dle approx­i­mate­ly 4mm from the edge of the wound and dri­ve it down far enough, rough­ly between 1/ 3 and 1/ 2 the nee­dle, so that when it comes up and out the oth­er side it is 4mm from the edge. Rein­sert the nee­dle clos­er to the edge of the wound on the same side that you just exit­ed then cross the wound and bring it up on the oth­er side near the edge. Then tie the knot., be sure the wound edges are togeth­er first. Repeat until the wound is closed.

Now what I just described is an all alone SHTF way to sew your­self up when you have no oth­er options. I do not claim to be the be all, end all of sutur­ing and a lot of what I explained was writ­ten for the aver­age per­son to fol­low to get the job done until they can get in and be seen by a physi­cian.

If you want to get a lit­tle prac­tice before you actu­al­ly need to do this, get a Chick­en or Turkey and prac­tice sutur­ing the skin back togeth­er

At all times watch for signs of infec­tion such as red­ness and swelling that is hot to touch, or a foul smelling drainage. If the dress­ing gets wet change it at as soon as pos­si­ble

Con­trary to what our par­ents and grand­par­ents have told us, let­ting the wound breathe by keep­ing it exposed to air is one of the worst things you can do.  Moist, not wet or dry, is the best way to heal a wound. Using a lay­er of antibi­ot­ic oint­ment cov­ered with a sim­ple gauze dress­ing will do this just fine.

For wounds of the scalp under the hair I like to use sta­ples. The down­side to sta­ples is that you will prob­a­bly need an assis­tant and you need a spe­cial sta­ple remov­ing tool. I have seen sur­gi­cal sta­ple guns at farm sup­ply stores also. The tech­nique is essen­tial­ly the same as sutur­ing, except that you pull a trig­ger instead of tie a knot.

Here a few ref­er­ences:

• Ditch Med­i­cine by Hugh L. Cof­fee is a great book and one of my sur­geon friends rec­om­mends it. ISBN 13: 978–1‑58160–390‑3
• Boston Uni­ver­si­ty Sutur­ing Basics by Wayne W. LaM­orte MD
• www.bumc.edu/generalsurgery/technical-training/basic-knot-tyinguturing/
• The Ethicon Knot Tying Man­u­al is a great resource also if you can find one.