William W. Forgey, MD
Soft Tissue Care and Trauma Management Part 2 - Wound Closure Techniques
Updated: Nov 12, 2020
Excerpt from The Prepper's Medical Handbook. Page reference numbers point to more in-depth treatment and self-reliant care available within the book.
WOUND CLOSURE TECHNIQUES
With direct pressure still applied, dry around the wound. We are now ready to enter the wound-closure phase of wound care. Perhaps more worry and concern exist about this phase of wound care than the others, but it is really the easiest—and much less important than the first two phases just discussed.
Tape Closure Techniques
If the laceration can be held together with tape, then by all means use tape as the definitive treatment. Butterfly bandages are universally available and generally work very well. The commercial butterflies are superior to homemade in that they are packaged sterile with a no-stick center portion. They can be made in the field by cutting and folding in the center edges to cover the adhesive in the very center of short tape strips, thus avoiding adhesive contact with the wound. Of course, such homemade strips will not be sterile, but in general they will be very adequate. Steri-Strips and their generic equivalents are now commercially available in neighborhood pharmacies. The ideal wound closures, they are lightweight, inexpensive, and easy to apply.
When using a tape method of closure, adhere the strips next to each other to opposite sides of the wound, then use them to pull the wound together as you proceed down the wound length, closing it as you go. Even with very sticky tape, there may be times when they cannot hold a wound closed and the wound will have to be stapled or sutured (stitched).
A fast, strong method of holding skin edges together is with the use of stainless-steel staples. A special disposable device will contain a certain number of sterile staples that rapidly staple the wound edges while pinching the wound together. This obviously stings while being used, but the pain is brief and the wound is securely closed. A very useful device is the Precise Five-Shot Skin Stapler by 3M, which obviously contains five staples. A special disposable staple remover is very handy for removing staples virtually painlessly. The skin stapler and staple remover are nonprescription and shown in figure 6-4. They come packaged in sterile, waterproof containers.
Suture (stitching) material is available in many forms and with many types of needles. For the expedition medical kit, I would recommend using 3-0 nylon suture with a curved pre-attached needle, shown in figure 6-5.
This comes in a sterile packet ready for use. It will be necessary to use a needle holder to properly hold the suture. The needle holder looks like a pair of scissors, but it has a flat surface with grooves that grab the needle and a lock device that holds the needle firmly. Hold it as illustrated to steady the hand. All fly-tying stores sell needle holders.
Apply pressure in the direction of the needle, twisting your wrist in such a manner that the needle will pass directly into the skin and cleanly penetrate, following through with the motion to allow the needle to curve through the subcutaneous tissue and sweep upward and through the skin on the other side of the wound; see figure 6-6.
DEPTH OF SUTURES
Suture through the skin surface only and avoid important structures underneath. If tendon or nerve damage has occurred, irrigate the wound thoroughly as described previously under “Clean the Wound” and repair the skin either with tape or sutures as necessary. The tendon or other structures can be repaired by a surgeon upon return to the outside—weeks later if necessary.
It is important to have the needle enter both sides of the wound at the same depth or the wound will not pull together evenly, and there will be a pucker if the needle took a deep bite on one side and a shallow bite on the other; see figure 6-7.
A square knot is tied with the use of the needle holder in a very easy manner, as in figure 6-8. Frankly, a knot tied in any fashion will do perfectly well.
SPACING OF STAPLES AND SUTURES
The stitches should not be placed too closely together. Usually, on the limbs and body, 4 stitches per inch will suffice. On the face, however, use 6 per inch; here it is best to use 5-0 nylon, as it will minimize scar formation from the needle and suture. I use a 6-0 suture on the face, but it is considerably more difficult to use than the 5-0.
These stitches can be combined with tape strips or butterfly bandages to help hold the wound together and to cut down on the number of stitches required.
Once they are in, leave stitches in the limbs for 10 days, in the trunk and scalp for 7 days, and in the face for 4 days. A wound that tends to break open due to tension, such as over the knee, can be stabilized by splinting the joint so that it cannot move while the wound is healing.
Keep an eye out for future post which will cover abrasions, puncture wounds, splinter and fishhook removal - to name a few.
View related Soft Tissue Care And Trauma Management posts
Part 3 - Special Considerations and Other Types of Wounds
Part 4 - Finger / Toe Problems, Wound Infection and Skin Rashes