Thursday, March 22, 2018

Wound Closure

Having been an “accident-prone” child, and then working with my hands for most of my life, I have developed an appreciation for skilled wound closure. My job puts me near a lot of agricultural equipment, which is either designed to be sharp or ends up worn to a razor's edge from use. Once something breaks, it's rarely a smooth break and there are jagged edges of wood and metal that need to be worked around.

I don't mind having scars, but if the medic closing a cut knows what they're doing, the scars are much less visible and the wounds heal much quicker.
  • I've had an intern suture up a 2” cut on my knee and when I went back after a week to have the stitches removed, they required a doctor to dig them out with a scalpel. 
  • The surgeon who worked on my neck was kind enough to make the incision in an existing fold of skin and used Steri-strips to close it instead of sutures, so the scar is really hard to see. 
  • I've seen a friend go through two weeks of IV antibiotics because a surgeon sutured up an incision so sloppily that there was a fold of skin between two stitches, leading to a nasty infection. 
Natural disasters like tornadoes and hurricanes produce a lot of damage, creating a myriad of ways to get hurt, and simple wounds like cuts and small punctures are common when you work around sharp things. If local medical infrastructure is damaged or destroyed, you may find it handy to know how to close minor wounds on your own. If you run into something that is beyond your abilities you need to find professional help, so know where your limits are and where that help can be found.

Suturing is a skill that takes practice, skill, and some training. Luckily, there are resources available to the average person that will allow you to get the practice and training. 

I am not a doctor, I don't even play one on TV. The following is presented for educational and informative purposes only. I am not responsible for any actions you take, whether you read this or not.

Animal First Aid
Part of raising livestock is learning when you need to call the veterinarian and when you can deal with a problem on your own. Dogs run into sharp things once in a while, and sometimes they get into fights with other animals and get chewed up. Goats are pretty smart and nimble, but I've seen them lose a battle with barbed wire fencing. And any hoofed animal can injure themselves or other animals during the breeding season; those horns and sharp hooves aren't there for decoration.

Since veterinarians aren't supposed to work on humans, they aren't as closely regulated as actual physicians. Looking around the Internet, I've found several mentions of things like antibiotics for fish tanks being identical to those requiring a prescription for human use. A lot of other medical gear is available without a medical license if you start your search with “vet supplies”.

Learning How
A quick Amazon search shows several medical school texts covering wound closure, but they run $50-100 apiece. There are some less expensive manuals to teach the basics, like the US Army training manual (Kindle edition only) for $12.00, or a used copy of one of the manuals printed by a suture maker for about $20.00. These will teach you the basic knots and how to choose the proper material and size of suture for differing types of wounds.

Once you have something or someone to teach you the knots, you're going to need to practice them. There are rubber practice pads available, but I learned a few simple techniques on a chicken from the grocery store. 
  1. Buy a whole chicken, or at least a large uncooked piece. A whole chicken will give you lots of room to practice and will help some people get over the squeamish feelings associated with sticking a needle into flesh.
  2. Use a sharp knife to cut into it. 
  3. Practice sewing the cut closed until you're happy with your handiwork.  
  4. Unless you're using sterile sutures and working on a clean table, I would advise that the test chicken be discarded rather than eaten when you're done. 
Sutures are readily available at most farm supply stores; look in the veterinarian aisle. If you live in an area without a Tractor Supply, Bomgaar's, FleetFarm, Farm Supply, or Rural King store handy, they all have websites. You can also shop on Amazon, where $20.00 will get you a dozen “training” sutures and three tools for working with them. “Training sutures” brings up a good list to choose from and they will deliver just about anywhere. Once upon a time I got a couple hundred “expired” sutures from eBay, but that venue has been over-run with 'bots and scams in recent years. 

A lot of doctors have recently started using Steri-Strips instead of sutures if a wound is shallow or small. They are easier to apply and don't leave as large a scar, but they have a shorter shelf-life and need closer temperature control for storage. I may have to do some more research into this method, as I've had very limited personal experience with them.

Being a prepper means becoming more self-reliant, and being able to patch up minor wounds on your animals is a good way to save the expense of calling a vet. Plus, if you ever get into a situation where you need to close a wound on another person, having the skills and materials at hand could be life-saving.

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