Sunday, October 6, 2019

Wound Closure Supply Options

Disclaimer:  This is not medical advice and I am not a physician.  These are options people need to be able to consider when there is no doctor available, and options to be able to offer a licensed physician when standard care is not an option.
(This article first appeared 27 November 2018)

Here at Prep School Daily, we want you to know that when it comes to wound closure, you have options.  Options that will fit your budget and desired level of pain and scarring.  (All of these options assume that only the skin is involved and that there is no damage to underlying muscles, tendons, bones, ... vital organs.)

Option 1.  Do nothing.  Yes, this is an option.  You do not have to close a long cut or a wide cut, even if you have a big chunk of skin missing.  Just keep it clean.  Of course, it will take a whole lot longer to heal, and you will have a much bigger scar than if you had closed it.  $

Option 2.  Skin glues.  You can only get Derma-Bond through a physician.  Vet-Bond, the veterinary equivalent of Derma-Bond, is still available without restriction.  It is chemically similar to superglue, but much less likely to cause a chemical burn, which is hardly desirable when you're wanting to fix someone.  It is ideal for closing smaller wounds on children and facial wounds when minimizing scarring is really a priority.  Vet-Bond does not go in the wound;  it goes above it.  The skin is held together and then the glue is spread on top while the skin continues to be pushed together until the glue dries.  $$$

Option 3.  Steri-Strips.  These are adhesive strips of tape usually 3-4" long and 1/10-1/2" wide.  They are especially valuable for older folks with paper-thin skin and for children on body parts that don't see a lot of action.  Do not buy knock-offs, if possible.  The adhesive usually is not as strong, and they often have square corners that catch on everything as opposed to the rounded corners of Steri-Strips.  If possible, paint on lines of tincture of benzoin where the strips will go to help them adhere better.  $$

Option 4.  Staples.  Ideally, the staples would come from an actual skin stapler rather than the one you got from Home Depot in your tool box.  Staples are best suited to use on the abdomen, back, and scalp.  They do not go over joints (too much movement) or on the face (too much scarring) unless you really want that Halloween look all your life.  They are used in the field because they are very quick, which is nice if you don't have anesthetic, and because it requires almost no skill to be able to use them.  $$$

Option 5.  Duct tape.  This can be cut into strips and used just like the Steri-Strips above.  However, some people have a reaction to the duct tape adhesive.  The Youtube video shows how to make what's called a combat bandage with duct tape.  It's not my favorite idea, but sometimes we need to be able to improvise, so it's good to learn about it and be able to keep it in mind.$

This Youtube shows how to make a suture that isn't actually a suture.  I don't like it as much as the one I included when I originally wrote this post in November 2018, but those instructions have disappeared completely.  This guy uses toothpicks where I would use synthetic yarn and a honking yarn needle and cotton string where I would use a hand sewing needle and thread.  One of the great advantages of this method is that you are not actually piercing the skin; there's no pain inflicted, no anesthetic needed, and no additional possibilities of introducing infection.  I like it!  Oh, and with all of that, because there is no needle and no medication, you can't be accused of practicing medicine without a license.

Option 6.  The medical world's answer to the DIY solution above:  It has the medical grade tape and uses tiny zip-ties to close the wound instead of a needle and thread.  $$$

Option 7.  Suture.  Hopefully you will never need a suture for yourself or anyone in your family, but you sure as heck want to have them if you need them.  Sutures aren't all that expensive, but a physician just cannot be expected to purchase and store them for an entire community.  There are all kinds of sutures out there, and they all have their pros and cons.  Unfortunately, sutures for people are only available through licensed medical personnel.  Amazon sells veterinary sutures "for training" that are not necessarily high quality--the needles may not be as sharp, thus inflicting more pain on the patient. sells sutures for "veterinary use."  They are sterile and available in a wide variety of sizes and materials.  There are absorbable and non-absorbable.  There are natural and synthetic sutures.  The needles vary in size, shape, and purpose.  The most commonly used sizes are 2, 3, and 4, half circle, reverse cutting.  $$

Option 8.  Needle and thread.  Yes, you can actually use a regular needle and thread.  If you're going to go this route, at least get some spools of silk and nylon or fishing line.  The risk of infection is going to be higher with this option, and so is the pain.  For a more pleasant suturing experience, choose quilting needles instead of yarn needles.  $

Option 9.  Hair.  If the wound is on the scalp (or I suppose, really hairy arms or chest),  braid or tie hair over  the wound to close it up.  $

Option 236.  Agave cactus needles and the attached fiber. $

Option 237.  Combat army ants.  Find the ants, pick one up and have it bite you with the jaws straddling your wound, then detach the head from its body.  (Oh, darn.  I'm out of luck.  We don't have those kinds of ants around here.) $

Option 238.  Herbs:  Lantana, plantain, and Usnea have shown great ability to help speed wound closing.  $

As you can see, we at Prep School Daily have suggested a number of options that can fit any budget and skill level.  It's up to you to decide what will work best for your situation.

Which options you choose for closing a wound depend on a number of factors.  What materials do you actually have available?  What is the age and mental status of the patient?  Young children can be difficult to work on.  Are you able to suture a screaming toddler?  After the child has had such a traumatic experience, is it really going to work to have him come back to have sutures removed?  Is the wound over a joint?  Then a regular suture or needle and thread might be your only effective options.  Do you have anesthetic available?  How skilled are you?  Can you tie a suture?  How much time do you have?  Glue is quick, staples are faster.   Sutures take forever unless you are very skilled.   Regardless, use the least invasive method possible.  I had a former ER physician tell me that a lot of the sutures he saw being placed in the ER could have been done with glue instead.  Why were sutures used in those cases?  Well, for one, if doctors use more glue, parents will use glue more at home as well, and be less likely to come into the ER.  Secondly, when they're going to be paying a hefty ER bill, they want to see something substantial, like a suture, rather than a dab of glue or some Steri-Strips.

Keep in mind, this was just a post about the supplies you want to have on hand for situations you might face.  How to clean a wound properly, how a wound should be closed, and whether a wound should be closed will be covered in future posts.

And here's hoping, again, that this is more useless information you will never need to use.

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