Superglue instead of stitches

The disposables are exactly that - use them once & trash them. They can be found (in the 5-staple or 15 staple version) for less than $10. There is a trade off of weight for convenience, but they are easier to use on skin than sutures, they have less tissue reactivity, and they are less likely to introduce infection than the standard suture material/needle holder/forcep technique.

As far as sutures as needle & thread - they will work, but my personal preference for field use is heavy-duty nylon carpet/upholstery thread w/ a large needle (although you can find eyed surgical needles & they do tend to be sharper than sewing needles), and the heavy duty thread really isn't suitable for wound closure, if you want to do a nice job..
 
Flotsam said:
I've sewn myself up before (under sterile conditions), but never would I suggest suturing or gluing a wound in the field. You definitely risk infection , especially w/ any wound that really needs stitches (most wounds will heal just fine without them). I'm of the wash it out (use clean water or saline, if you have it - betadine, peroxide, iodine are all toxic to tissue & retard wound healing), and either loosely approximating the skin w/ steri-strips, or packing the wound w/ gauze & covering -crowd.

This is correct. Very small inscisions can be closed, but for the most part, anything that requiers stiching has too great of chance of becoming infected if sealed. The would should be packed with moist gause to prevent it from sealing.

Any wound should be irragated as you point out. Moist antisepctics, like the ones you mention are too strong, and will kill the living tissue. Dead tissue is where baccteria grow, and using peroxide or iodine will encourage infection. Killing all the bacteria in a wound is difficult, the idea is to prevent it from gorowing by removing as much dead tissue as possible. A 1% providone solution, or a 1:750 solution of benzalkonium chloride is safe to use and will not kill tissue. It is OK to risk using something strong on animal bites where there is a risk of rabies. Benzalkonium chloride is good to use because it can kill rabies.

Will
 
Will said:
This is correct. Very small inscisions can be closed, but for the most part, anything that requiers stiching has too great of chance of becoming infected if sealed.

For knife work, cuts are common on the hands and fingers, stitching them allows you to use the hand to a much greater extent and will allow the wound to close *much* faster.

I have stitched very small cuts, 2-3 stitches for this reason. In areas where there is little to no tension, they usually are not necessary, I do them mainly for practice, a couple of times a year or so.

I have never once got an infection, it is supposed to be much worse in the tropics with the heat and humidity, so that would need to be of consideration.

-Cliff
 
Cliff Stamp said:
For knife work, cuts are common on the hands and fingers, stitching them allows you to use the hand to a much greater extent and will allow the wound to close *much* faster.

I have stitched very small cuts, 2-3 stitches for this reason. In areas where there is little to no tension, they usually are not necessary, I do them mainly for practice, a couple of times a year or so.

I have never once got an infection, it is supposed to be much worse in the tropics with the heat and humidity, so that would need to be of consideration.

-Cliff

Is it hard, or painful to stitch yourself? I don't think I could do it. Why not just use steri-strips?
 
In my experience, it does hurt a fair amount to suture yourself, especially on the hands due to the greater number of nerves. I've always used a little lidocaine. I've only done a couple of stitches on myself w/o lidocaine - it definitely hurt. I've only sewed myself up when it was a clean cut, from a clean tool, and I had access to the proper supplies to take care of the wound. That said, a steri-strip, and a bandage works quite well, IME, w/o too much loss of dexterity.

If I was routinely sewing myself up, I'd consider changing my habits. :)
 
It is awkward, but isn't difficult, it isn't what I would call painful, it is just a needle going into the skin. I carry steri-strips, they work well for some cuts but don't have the holding power that sutures do especially if the area of the skin changes tension with movement. They also don't sell them in individual sealed packs which is irritating.

Similar to how to handle blisters, there is a temporary solution which works well in low stress and a permanent solution which works well in high stress where you need to keep using the effected area. Ideally you just rest and don't do anything and it gets reabsorbed and heals, but if you have to keep going you need to do something.

Anyway for stitches and cuts in general, after stopping blood flow and cleaning the wound I check for movement and loss of feeling and deepness, if either of these are an issue and it is possible I'll take a trip to the emergency room.

-Cliff
 
Especially in the field I apply betadine or provodine iodine before doing sutchers (after properly cleaning the wound). I also carry butterflys for the less serious custs.
I have considered the cyanoacrylates but have not found what I would consider a fool proof, spill proof, method of carying them (burst a bottle, or capsule, and the rest of your supplies in the same pouch could become unusable, or at least dificult to separate).
Just my $.02.
Enjoy!
 
First of all Dermabond is good. In the wrong hands it horrible. I work as a Physician Assistant and seen some nasty infections caused by gluing in a dirty wound. Stitching is really for a clean wound. And even then sometimes you "loosely approximate" the edges so that the body can heave out the bad stuff. Suturing too tightly and gluing are bad things.


I can't really imagine a situation were bandaging wouldn't suffice. Unless you are stuck out for long term.

Whatever you do, you need to watch and keep clean, Infection starts and you are in big trouble.


Paul
 
Flotsam said:
The pinesap, etc... crowd is more a testament to the rejuvenation abilities of the body, and less to the efficacy of home remedies. And that's the point - the body (esp. in a young, healthy person) will heal just fine on it's own. .


Pine sap is actually a medium strength antiseptic with some strong healing properties. Not to mention it holds a wound shut. Not your first choice but if you had to......

Skam
 
I use that all the time on small, simple cuts that need no inner stitches.

- Clean, disinfect, stop the bleeding, disinfect again. Dry the wound site.
- Close the wound, and apply a line of glue all over the joined gaps (parallel to the cut). Both "lips" of the wound must now be wet with glue. Don't put too much or it'll burn a little (hardening of glue = exothermic reaction).
- Hold for 15 secs.
- Suture done. Wrap if you think it's required.

Another method, better for infection-risky cuts, is to put a few dots of glue instead of a whole line. That leaves small gaps for infection to come out of the wound site. You don't want any infection or pus to stay inside your skin an develop there. An infected wound is better left partially open.

Nota bene : some wounds require INNER stitches. Any wound deeper than 5-6 mm, that affects other tissues than skin (muscles, ligaments, fat tissue, nerves, etc.) absolutely must be treated by a pro. You cannot make inner stitches with super glue. In such a case you need "melting" stitches.

No problem so far with any kind of super glue. As it "coagulates" instantly in water, it hardens as soon as it touches blood or the inside of the wound. It doesn't sting, doesn't burn unless you apply a lot too much of it, and I experienced no harful side effets so far. This is no insurance policy, just my own experience with it.

Cheers,

David
 
Jason Burns said:
...Once I cut my pinky to the bone while doing a cord wrap on a CRKT stiff KISS . . . had to go to the ER and they used Dermabond to put it back together and it did wonderfully!

...in Central America you CAN get stitches but they look Horrible and leave bad scars...I used superglue...I had to reapply several times and eventually go to steri-strips...

First, sounds like a BAD ER that doesn't know proper wound care/technique.
Second, scars from suturing is a matter of the type of suture and the tension. Reapplying a chemical with inflamatory properties is just asking for a bad scar and you were lucky. You should have gone to steristrips to begin with.

skammer said:
...I clean the cut out with diluted providone iodine, let it dry and then closed the wound and seal it on top with the glue...

The best proven substance to clean a wound is sterile normal saline. Iodine actually inhibits migration of the appropraite cells needed for healing and combatting infection. Just irrigate the wound copiously with sterile saline!


pcnorton said:
...Stitching is really for a clean wound. And even then sometimes you "loosely approximate" the edges so that the body can heave out the bad stuff...

You can SUTURE just about any wound as long as there are healthy fresh edges and the wound is well irrigated. If you are closing a "field wound" you should loosely re-approximate it if you need to close it. Remeber, not all wounds shallow or deep need to be closed!

Cedric said:
...Dermabond is a great tool, but it has to be used in the appropriate application...

Couldn't agree more. It is all about the tool and using it correctly. Crazy glue is always the wrong tool for the job.

blgoode said:
...do you apply the glue on TOP of the cur or IN it?
Good thread!

Dermabond and other appropriate medical glues with the exception of BLOOD PRODUCT derived glues are applied on the outside of the wound NOT in the wound.

EMedicine said:
...Inflammation, tissue necrosis, granulation formation, and wound breakdown can occur when cyanoacrylates are implanted subcutaneously...

Irrigate your wounds and just use steristrips! Glues sound cool but you do NOT need them and they have a limited realm of "proper" applications.


Just my 5 cents....being a surgeon and all.

PS: yes, I know this is an old thread.
 
LSkylizard said:
The best proven substance to clean a wound is sterile normal saline. Iodine actually inhibits migration of the appropraite cells needed for healing and combatting infection. Just irrigate the wound copiously with sterile saline!

Just my 5 cents....being a surgeon and all.

PS: yes, I know this is an old thread.


Doc,

Some good points made however in an austere environment it "IS" a known Wilderness medicine protocol to use a diluted providone iodine solution as it will kill embedded bacteria with little tissue damage where as plain saline will not.

ER and surgical protocols are VERY different than wilderness treatment. There is no golden hr and no 15 min response times 4 days from electricity.
This topic has been debated and settle upon by dedicated wilderness medical societies, physicians and WEMT's.
Saline will flush a wound clean short term but could and does leave a high bacteria load in the wound bed when it can't be cleaned thoroughly. The problem is nobody carries sterile saline in the woods for the most part and the available water needs the iodine to clean the water as well as the wound while irrigating.
In the city this is not a problem, 4 days or more from help this is an issue.

For regular cuts and lacerations flushing with city tap water is about as good as it gets and the latent chlorine has a very mild cleaning action as well.

The public have no need to stock up on sterile saline for simple wound irrigation and there is no first aid, city or wilderness protocol taught that supports this claim as far as I know.

Skam
 
skammer said:
... "IS" a known Wilderness medicine protocol to use a diluted providone iodine solution as it will kill embedded bacteria with little tissue damage.....Skam

I deal extensively with SURGICAL WOUND CARE. I see extensive wounds days, weeks, and months old before patients arrive for debriedment and or hyperbaric oxygen treatment and/or amputation.

Dilute iodine: the first and foremost thing for a wound is copious irrigation no matter what a survivalist may have said or been lucky to have occur to them. It goes without saying that if you need an iodine tablet to sterilize your water supply then you do that. None the less, water should be your first line NOT watered down iodine...because anecdotal experience aside the medical wound care literature shows normal saline to be best and iodine and other caustics do in fact inhibit wound healing (there are special exceptions in which you do just the opposite and pack the wound with iodine). Remember, when someone comes to the operating room septic because they have perforated their colon (stool and corn in the belly), we irrigate with normal saline....NOT iodine.

skammer said:
...Saline will flush a wound clean short term but could and does leave a high bacteria load in the wound bed.....Skam

That is the point! Copius irrigation is NOT to sterilize the wound. It is to decrease the bacteria load to enable your bodies natural defenses to take over. There is no real way to completely sterilize a wound without inhibiting the bodies ability to heal after you have chemically burned it. If, you copiously irrigate (with normal Saline), you markedly decrease the bacteria load which has been demonstrated repeatedly in the dirtiest of wounds to include perforated intestines.


skammer said:
...The problem is nobody carries sterile saline in the woods for the most part and the available water needs the iodine to clean the water as well as the wound while irrigating......Skam

I will say it again; It goes without saying that if you need an iodine tablet to sterilize your water supply then you do that. That fact that you do not carry the right treatment does no support using the wrong treatment. The key is to irrigate the wound with a non-caustic (at the cellular level) solution. Copiuos irrigation does not mean a little rinse it means more then a liter of solution!

skammer said:
...The public have no need to stock up on sterile saline for simple wound irrigation and there is no first aid, city or wilderness protocol taught that supports this claim as far as I know...
Skam

Some final points. Any good physician knows that ultimately the individual will heal in spite of what we do and rarely is it the case that the patient heals as a direct result of what we do. The best a medic or physician can do in wound care is optimize the healing environment. This means removing dead tissue, removing foreign material, and copiously irrigating to decrease the bacteria load in a manner that does NOT leave irritated or shocked tissues.

Let's face it, some out their still believe wound cleaning is best achieved at the end of a dog's tongue! Others saw "The Outlaw Josee Wales" and believe packing wounds with mud "because of good bacteria" still works. Just because some survivalist have succeeded using interesting methods does NOT mean it actually applies to the entire world. It simply means they got lucky and their body could tolerate more of an insult.
 
LSkylizard said:
It goes without saying that if you need an iodine tablet to sterilize your water supply then you do that.

That's pretty much the point, you can't carry around enough sterile saline for irrigation plus water to drink, usually you can't even be expected to have the latter in a survival situation. Now you could just carry the purified water and make a saline solution, are the ones used for irrigation isotonic with the blood? What concentration should be used? Even then though you would have to consider the use.

For many emergency situations throwing liters of water on the ground would not be practical, though you could contain it and use evaporation to get rid of the salts depending on the enviroment. Water is heavy though and quite frankly, this really isn't a practical/efficient solution, especially for any extended stay.

It isn't a matter of not knowing what to take, it is a matter of what is practical. The best solution to fell a decent size tree is a small chainsaw, however it isn't a practical solution to carry a saw plus what you need to run it in many outdoor activities thus you revert to other means. It isn't about what is ideal, it is about what you have available.

Thus you could purify the water, then attempt to steralize with iodine, then evaporate and recollect and add the salts to make a solution, once you get set up. I don't think I have heard anyone recommend this, doesn't mean it isn't the way to go though if you have any time.

Do you have any papers on the use of iodine solutions vs saline on wound treatments in regards to healing with no other treatments?

-Cliff
 
Cliff Stamp said:
...are the ones used for irrigation isotonic with the blood? What concentration should be used?...
-Cliff

Ideally you use 0.9% saline (i.e. "normal saline").

Cliff Stamp said:
...For many emergency situations throwing liters of water on the ground would not be practical...It isn't a matter of not knowing what to take, it is a matter of what is practical...It isn't about what is ideal, it is about what you have available...-Cliff

It may not be practical but neither is doing the wrong thing. From that line of logic, your dog and/or mud are available so have him the wound or maybe pack it with mud. The truth is it is about doing the right thing not just doing something to do something. If you do the wrong thing and make the wound worse you have achieved a very impractical situation. If you injure the wound base with a chemical because you have it available, you have NOT achieved a practical solution. In a survival or any other situation clean the wound the best you can. This does not mean throw chemicals at it just because they are antibacterial. You may NOT have liters of normal saline available for irrigation. Then you calculate how much water you can spare and you use what you can spare. You accept the possibility that infection will set in from inadequate irrigation and leave the wound open (control the hemorrhage though) until you can obtain better care. However, you do not injure the wound base with chemicals just because that is what is available. Spritzing betadine/providone solution into the wound does NOT adequately irrigate and leaves foreign material as well as injured tissue as prime nidus for infection.

Cliff Stamp said:
...I don't think I have heard anyone recommend this, doesn't mean it isn't the way to go though if you have any time....-Cliff

No, I don't think you can pack gallons of water just in case you hurt yourself. You take what you think you need. If your situation allows, you do boil water and irrigate the wound copiously. You do the best you can...which is not squirting iodine and chemicals into wounds or using crazy glue to avoid a wait at a local emergency room (actually discussed this in this thread).

Cliff Stamp said:
...Do you have any papers on the use of iodine solutions vs saline on wound treatments in regards to healing with no other treatments?...-Cliff

There actually is wound care literature about different means of irrigation. They have even looked at things such as Normal saline, iodine, water, antibiotic solutions, etc... Nothing has shown benefit over normal saline and chemicals have shown detriment. It is an interesting topic you can possibly find online or check at a local hospital library. I do not keep these articles around because the topic is not one of great debate amongst wound care surgeons rather one debated by ....without intending to insult.... medics and/or others passing on anectdotal experience without really knowing much about the pathophysiology of wounds and healing.
 
At the end of the day Wilderness "NOT" Hospital based protocols for austere wound care recommend diluted Povidone iodine based irrigation as a means to knock down and remove bacteria and particulate. In a hospital based environment I am sure saline is the prefered method although there is some litterature supporting iodine use as well.

The goal of flushing the wound is particulate removal. 100% particulate and bacteria removal in the hospital is possible, in the field it is impossible thus diluted iodine irrigation is the norm. 4 days from a surgeon the goal is to avoid sepsis, mere saline flushing that doesn't remove all particulate is a lessor treatment under those conditions. It is very easy to carry some small iodine swabs and drop one into a zip lock baggy full of cleanest water, prick a hole and use to irrigate under pressure.

This is not new or groundbreaking. If one questions this protocol then one should make a case with the various wilderness medical societies and their governing physicians.

Skam
 
LSkylizard said:
From that line of logic, your dog and/or mud are available so have him the wound or maybe pack it with mud.

If water wasn't available then yes you would have to look for other options, it isn't about what is optimal, it is about what you can do. Specifically here we are comparing flushing with saline vs flushing with an iodine solution.

I did some checking on pub med, with no bacteria load it doesn't hurt and healing time is the same :

http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=11359886&query_hl=9

and when the bacteria load is high it is effective at reducing it :

http://www.ncbi.nlm.nih.gov/entrez/...&dopt=Abstract&list_uids=12753370&query_hl=13

For those curious, a periodontal pocket is when the gums no longer form a tight seal around the teeth, they get inflamed and food gets trapped there and bacteria sets in.

The above study also showed that you needed to remove the debris to lower the bacteria count, similar to wounds, you can't flush with an anti-bacterial and expect it to work if the wound isn't fully cleaned.

Anyway after checking pubmed for about a half an hour it seems that if the wound is clean and sterile then it doesn't hurt, but doesn't help, if the wound has a high bacteria count it can help.

For those who want to do some reading, the main entry into pub med :

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi


-Cliff
 
Without trying to be insulting I have to say, “you must be joking or smoking crack to apply those references to this topic or suggest they are evidence of anything!”

First, you reference a study of periodontitis. The study has 16 patients. I suggest you ask someone at the NIH about the statistical significance of that or its applicability. You are talking about the oral cavity. It is a special, highly vascular, rapid healing tissue that often heals without scarring. The patients are already infected. Their mouths are “irrigated” and “debrieded” by a periodontist in an office. The study authors themselves state, “…subgingival irrigation with PVP-iodine without concomitant mechanical debridement might not improve microbiological and clinical variables in comparison with saline irrigation, at least not in sites with radiographic evidence of subgingival calculus.”
I find no stratification or accounting for confounding factors such as age, sex/gender, tobacco usage, diabetes, baseline dental hygiene, etc…(likely can not with only 16 people). I would be surprised if these 16 patients didn’t receive antibiotics during this study as well.

Second, you reference a study of wound dressings after “…nail matrix ablation using phenolization…” in 42 patients. As in the previous study, I suggest you ask someone at the NIH about the statistical significance of that or its applicability. Again, you are talking about a medically controlled experiment in a very small sample size, under supervision and clean conditions. They did not irrigate these wounds, rather laid an impregnated dressing over them. I find no stratification or accounting for confounding factors such as age, sex/gender, tobacco usage, diabetes, etc…(likely can not with only 42 people). What was the exclusion criteria???

There are to numerous websites providing frightening misinformation. Anyone can read through this thread and at least see a medically based perspective. If someone wants to gargle providone, so be it. If they want to start dumping chemicals onto their kids wound to avoid waiting in the ED, that’s unfortunate. In closing, you can do anything you want it doesn’t mean it is the right thing. If you do not have the appropriate irrigant, you shouldn’t just irrigate with the wrong one simply because it is available or because a dentist somewhere did it to 16 people in their office. Sometimes, you can’t do anything because you do not have the resources at hand. That doesn’t mean just do something to do something. By all means, continue to research this and find “disposable” publications to convince yourself you are right. I will not change your mind until you have a greater knowledge and understanding of what a good medical study is and what its applications/implications are. Until then, you will probably continue to buy whatever these 16-42 subjects studies are selling.


I am not going to argue this point anymore. Suffice it to say that periodontitis and chemically burned nail beds are not the same thing as a cut, scrape, or stab wound in the woods or at home for that matter.
 
LSkylizard said:
NOT true. 100% removal does not occur, thus wounds are often left open.

Split hairs, ok then a vast majority or a huge % of bacteria can and is removed in a hospital setting vs and austere environment. That said some nasty infections are hospital based, people go in and dont come out.

Maybe a little iodine would help ;) haha.

In Cliffs defense there is a TON of references supporting this wound cleaning technique in wilderness medical litterature. Lets not play the quote game shall we.

But seriously take it up with the wilderness med associations as it "IS" protocol and taught at every level. Being a surgeon does not make one a wilderness med expert, far cry from it actually. We dont allow anyone, nurses, or Dr's without specific wilderness training to touch anyone whos rescue is not imminent. Matter of fact non wilderness trained Dr's of all types are very well known to be very poor first aiders. Most Docs know their training limitations and see the big liability neon sign blinking in these situations thus they stay out of it 100%.

Its the old story a doc can massage a heart but haven't a clue how to reduce a femoral break with no equipment 2 days from a bus.

If you are this interested join up get wilderness certified and bring to the forefront your concerns in an arena of equality and make your stand there.

Skam
 
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