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Stitching Wounds In Emergency Situations

Suture_Wound

This article was written by Lizzie Bennett and originally published at The Daily Sheeple

Suturing wounds is a double edged sword. There is a chance, that if the wound isn’t totally clean you will be effectively trapping the infection inside the wound. If the wound is clean, and you leave it open, it’s prone to infection.

Any wound that you intend to suture should be cleaned, re-cleaned and then cleaned again. I can’t stress this enough.

Stitching a cut does not seem like a particularly difficult thing to do, but suturing deep cuts, that that would usually be closed in two or three distinct layers, without local anaesthetic and proper surgical needles (which are curved and make the job much easier), is not as straightforward as it might seem.

If a wound is already suppurating, producing pus, or had debris in it that cannot be removed it should be left open. In addition, animal and human bites should not be sutured. Closure of these wounds will cause more harm than good and can lead to septicaemia, gangrene and even death.

Firstly, suturing a wound that is still bleeding is likely to cause a haematoma, a blood clot that could quite easily put so much pressure on other vessels that blood flow ceases and tissue damage occurs. This is especially true of the extremities. Some bleeding is good, the blood often brings with it debris that would otherwise contaminate the wound. What it will not get out is pathogens, germs from the object that caused the wound, or from the area directly surrounding the wound, people, animals, road surface, whatever.

If you have curved upholstery needles they make the job easier as they are more akin to surgical needles, but they take some getting used to. Take the time to practice suturing skills before a time you will need them. Soft skinned oranges such as Clementines are a good practice subject as the skin breaks easily, and you can get a feel for the pressure required.

Practicing on a piece of meat gives you an idea of what going through human tissue feels like.

Basic Suturing Technique in 7 Steps Using a non-surgical needles

1. Elevate the wound if possible, or use a tourniquet to stop the blood flow, a rubber glove stretched and tied around an arm to leg works well. When use of a tourniquet is impossible, use a pressure dressing. If you opt for the tourniquet whatever you use it should be wider than an inch to prevent it cutting into the skin.

2. Bleeding stopped, though oozing is acceptable, you need to look at the wound to see the extent of it, roughly how deep it is. Clean the wound with antiseptic solution if you have it, saltwater if you do not. Wait five more minutes, whilst your sewing needle and thread are boiled to sterilize them, and then release the tourniquet, if used, as slowly as you can. Blood rushing back into a limb, especially a leg, can cause a sudden and profound drop in blood pressure and is something to be avoided. Releasing it slowly also assists in not knocking off any small clots that have started to form at the end of the damaged vessels. If it bleeds profusely, reapply the tourniquet or pressure dressing and wait twenty minutes (five for fingers and toes) rinse the wound again to prevent collected blood clotting and obscuring your view. You may have to do this several times.

3. A deep wound is more than likely contaminated, if you have antibiotic capsules, open one up and mix with a little sterile water, just enough to turn it into a solution, and put it in the wound. Wounds heal by granulation, from the bottom up. Suturing is not actually required to ensure a wound heals, what it does is speed up the process and helps keep the wound clean. A deep gash will take weeks, sometimes months to heal if it is not sutured. Suturing brings the two halves of the wound together so that when granulation occurs the new grown cells mesh together forming a strong join, just suturing the skin would be worse than leaving it to granulate, you are creating pockets, a perfect place for germs to grow and flourish.

4. Okay, the sewing bit. Staying a little back from the wound edge put the needle in just off the vertical, like this…go down to as near the bottom of the wound as you can and pull the thread through leaving a 2-inch tail. Insert the needle directly opposite where you removed it and back up through the skin on the opposite side of the wound, at an angle just off the vertical, like this…cut the thread leaving a 2″ tail and repeat this process along the length of the wound.

5. Now they need tying off. Starting IN THE MIDDLE of the wound, gently pull both sides of one suture upwards and across each towards each other. Be gentle, tissue is delicate and tugging too hard will rip through the tissues. When the edges of the wound come together, or as near as together as you can get them to tie a knot, then two more. Now move to one end of the wound and do the same again. Now the other end of the wound and so on working towards the tied suture in the middle. The sutures should be placed about half an inch apart on long wounds, and about half that on short wounds. This spacing and working alternate ends prevent puckering of the skin which is very sore and can delay healing.

6. Dab the area gently with a decent antiseptic solution. Do not use cotton wool, the fibers get into the wound. Cover with a sterile dressing and leave for 12 hours. Twice a day for the first five days dab with antiseptic and cover with a fresh dressing. It is normal for the needle holes to look very red and to be sore. If pus leaks from the wound check every few hours, if it does to subside, or become thinner, or clearer within 48 hours remove the sutures, clean the wound and re-suture. Adding antibiotics to the wound prior to suturing usually prevents this, and it is standard practice in hospitals for grossly contaminated wounds.

7. The sutures need to stay in for between 14 and 21 days. To check if the wound is sound apply gentle opposing pressure with your thumb and fore finger between two of the sutures, If the wound does not hold together leave the sutures in and do the same test daily. To remove them, wet them with sterile salt water, cut the knots and tease them out. Do not cut all of the knots at the same time, check that the wound holds together by removing the center one first and checking as previously stated. If it is not quite there, leave the rest in and check daily. If the wound is sound, remove the rest of the sutures.

This wound will not have the best scar in the world, but it will be much more pleasing than a granulation scar, also, granulated tissue is often quite sensitive to knocks, bumps and sometimes even fabrics. Suture scars tend to be far less sensitive and are less prone to abrasive damage than is granulation tissue.

Disclosure: The information in this article is for informational purposes only. Nothing contained on this web site should be construed nor is intended to be used for medical diagnosis or treatment. Consult your physician or other qualified health care providers with any questions regarding medical care.

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ldiffey

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3 comments

  1. You may also want to practice on an orange and banana. With the banana peel the skin down, then try suturing it close without getting any meat from the banana on the suture.

  2. I am a physician.

    Although I am not a general sugeon (recognized wound experts), I have more than 25 years of experience seeing most anything you could imagine. I have no experience in combat related trauma.

    The only wounds that should be stiched closed are those relatively fresh that can be cleaned out well with betadine.
    A dirty wound, closed with suture will surely “puss out” into an abscess. In the medical field, skin closures that become contaminated (usualy staph bacteria) fail to heal at the margins an tend to come apart anyway. This would be a self rectifying process except foriegn material (suture) in the surgical site will allow the infection to persist. Sterile guaze packing, if placed into an infected or risk of infected cavity, slowly withdrawn will help the natural closure of the space from the inside out.

    I have witnessed dehised surgical skin closure, after entire foreign body (suture material) removed close up and heal in rdiculous openings, as long as the fluids/ pus can exit the wound. Some of them, in the final result looked better than a successful suture closure.

    I have seen open abdominal wounds from the sternam to the pubic bone close themselves over time if kept clean and free of pockets of abscess.

    In general, you should conside NOT trying to close open skin wounds. Clean, pack, slowly withdraw or change packing every 2 days.

    Regards,
    Frank Becky MD

  3. after cleaning my wounds,left arm, my wound was packed and left open , but plugged and wrapped so it could drain( boy did it stick after a time) then why i got to japan had another surgury and bad ass medal sutures back and front and a light weight cast. i guess it depend on the medic and type of wound. mine was from a chi-com claymore

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