Backwoods Medic: To Stitch or Not to Stitch

BWM1
Warning: If you choose to take any of the advice in this amateur post, do so with the full knowledge that it is at your own risk, that the advice is based completely on backwoods lessons learned and does not conform to any official medical sources or approval. The opinions are Grunt’s alone, and he has no medical training beyond being an Eagle Scout and spending a lot of time on ranches and in back country work camps with chain saws and idiots. All photos are by Grunt. Also, if you continue below the fold, some of the pictures may be scary. Just sayin’.

This very brief post is offered as a discussion of the common, reoccurring question after back country injuries are sustained: “Dude, do you think we need to stitch that?” It’s a good question. Due to the tendency of emergency room staffs to over-stitch, driven partly by the cosmetic desire to avoid scarring and partly by the desire to err on the safe side, we often think puncture wounds are worse than they really are in this regard. So how do you make the call?

BWM4In most cases where an injury has split the skin open, especially in the outdoors, stitching (after the wound has been properly cleaned and disinfected, of course) can be very helpful in keeping it clean, allowing mobility and speeding recovery.  In some cases, such as where the abdominal or lung cavity has been breached, it’s absolutely essential.  I don’t want to comment much on those cases because I’m not qualified to answer the critical question of whether surgery is necessary when the damage is that serious.  However, it’s helpful and encouraging to know that many soldiers and expedition crew have notoriously survived serious injuries of this nature for many weeks without medical attention, especially if they have good field help.

I’d like to focus on the fairly minor situation where a large gash or puncture needs to be kept together for healing, and the use of adhesives or tape is an option for doing so.  Should you then?  Or should you grab that needle and some dental floss or thread or barbed wire and just go for it?

It’s a judgment call, of course.  But the longer and deeper the gash, the more likely you want to stitch.  The flexibility of the skin area doesn’t enter the decision as much as you’d think.  If it’s a joint, like a finger knuckle or a knee, it will be a challenge to keep it together without stitches, but it will also be very likely to rip stitches during activity in the field.  So again, it’s a tough choice.BWM2

BCM3Let me illustrate with just one example.  This knee puncture (above) occurred during a fall against sharp granite talus.  It’s fairly deep and open, exposing some of the knee bursa, but no bone.  In my opinion, the gash isn’t long enough to stitch, even though they’d do it in the ER.  I wouldn’t think it’s even worth considering because a wound of this type will heal up quickly with minimal scarring if you can keep it from getting infected and keep some butterflies and bandages and tape on it for a couple of weeks.  The camo duct tape (right) is optional.

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About GruntOfMonteCristo

Fearless and Devout Catholic Christian First, Loving Husband and Father Second, Pissed-Off Patriot Third, Rocket Engineer Dork Last.
This entry was posted in Family Survival, Science. Bookmark the permalink.

71 Responses to Backwoods Medic: To Stitch or Not to Stitch

  1. barnslayer says:

    Good article. If you decide to stitch:
    Don’t pull too tight – more likely to tear and inhibits needed blood flow to tissue.
    Don’t stitch too close to edge of tissue – tearing
    All stitches become a potential source of infection (especially makeshift non-sterile materials) – keep an eye on it. Even optimal sterile stitches are removed in 7-10 days.

    • Thanks for the tips, Barn (who IS a doctor, unlike me). So, what’s the urgency to remove in 7-10?

    • Knight4GFC says:

      We’ve used sterile (boiled) horse hair before. But imo, I would lean more towards taping/bandaging before stitching. Stitching would be last resort. I’ve heard that regular superglue can be used where stitching would have been done too.

      • barnslayer says:

        Some ERs use sterile superglue. I don’t know if it’s got the same holding power as legit sutures so it might not work on a big nasty one. If you’ve ever used superglue on a wet surface (in this case bloody) you know there’s that to deal with too.

        • What A Hoot says:

          Super glue works for cuts that are NOT deep. Or where a butterfly would be used to pull together. Do not use if still bleeding. One time the sons were out late at night terrorizing (tp’ing) a friend’s home and they took off their shoes. When the lights went on in the house they took off running. One of the tag-along younger brothers, who was not supposed to be out, gouged open the bottom of his foot on a jagged stone. No problem, Doctor Big Brothers super glued the stitches; no need to tell Mom. Mom ended up taking the kid to hospital to get all the glue removed from inside the infected wound. It was one big blob and had to be cut out. Mom was not too hard on the offspring; more distressed that their friend’s parents had no sense of humor and kept the 24 rolls of toilet paper AND would not even let her precious baby use it to continue the warfare. Anyway, super glue is good for glorified paper cuts when the wound is at risk of infection OR getting poison oak in. I have found that on cuts a bit deeper and longer than a paper cut, that is a clean, non-jagged a butterfly can be applied and then super glue across the surface of the closed cut (under the butterfly). I personally think that all moms should be able to stitch or sg/butterfly as automatically as we can change a diaper. For the inexperienced, practice on an over-ripe but not rotten orange. (Oh, and now it is an act of vandalism to tp and the darlings will be arrested. Not because of the littering but because to be tp’d was a sign of having friends and some kids were getting left out!)

      • Knight, have you really used horsehair thread for sutures? How does that work, and was it bought or braided yourself? Interesting!

        • Knight4GFC says:

          I, personally have not used this method on myself or others… yet (I am prepered to, as I do carry my own stitch kit, supplied with horse hair and various types of suture needles). My family has used this method and I have been witness to the technique used on our animals. Once, I was called upon for my kit, because my aunt had run out of her own supplies while stitching up a horse. I assisted with my own.

          The horse hair is from our own horses, sterilized, and sealed for future use. As for braiding, I do not braid mine. The horse hair I am provided with, is pretty strong. We tend to pick the thickest hair strands. I would imagine though that if the situation required, I would braid my own.

          I have seen several success stories in animals, not humans… yet. My family has had a couple of close calls before in the past, but never went so far as to actually suture one’s lac up. It was usually taped shut after cleansing the wound.

          • That’s good to know, really. I didn’t know that horse hair was strong enough to allow a single strand for that use. Do the strongest ones usually come from the mane or the tail? I’m guessing the tail, but I’ve never really noticed, myself.

            It’s weird, I know, but I have paid a lot of attention to elephant hair. One of the side-effects of having a kid who works in a zoo, I guess. Their hair is way too thick and wirey to use for sewing of any kind. Maybe you could make mats out of it. The tail hair, in particular, is like 50-lb test fishing monofilament, and it looks like nylon or plastic. I guess they need it like that for brushing mud around on their rough backs.

            Knight, when your family sews up a horse, what kind of needle do they use for that hide? A big 2″ diameter curved carpet needle? Or just a standard smallish curved suture needle? I’m just curious because I’m in the process of refitting my kit at the moment.

            • Knight4GFC says:

              On the horse, we used a 2″ curved needle. I would suggest carrying several suture needles of various sizes. I carry both curved and straight of different sizes.

              The horse hair we select is from the tail. The tail is strong but long as well.

              • Thanks! I don’t usually carry one with me in the back country, but I have a couple of surgical clamps that come in really handy some times, especially when using the small curved needles. The clamp really helps manipulate the needle in tight spaces. Come to think of it, I probably should carry a clamp all the time in the outback. It wouldn’t be heavy, so why not?

              • Knight4GFC says:

                I agree with you Brother Grunt! Surgical clamps do work well with the needles. Carrying a couple of these clamps is a great idea. I should get some as well. 🙂

              • You know where I got mine? Radio Shack. Of all places. Only place I’ve ever seen them for sale. I’m guessing they come in handy for soldering, too, but I’ve never used them for that.

              • Knight4GFC says:

                Wow. Radio Shack? I’ll need to pay them a visit. Hey Grunt. I had an open question to all about NOS below. do you have any knowledge on this?

              • barnslayer says:

                The clamps we use are called needle clamps or holders. They’re a lot like hemostats but the ones I use are shorter and a bit heftier. The needle is always curved about 3/4 inch.
                I don’t know what you would use a straight needle for on people.

              • Knight4GFC says:

                I have never used a straight needle. I carried but never used. I was thinking about how use full straight needles might be and couldn’t figure it out. So I carried anyways just in case. Maybe I should stop. Perhaps they are useless. Only curved needles.

      • filo says:

        Ive used dental floss a few times on myself

  2. ZurichMike says:

    ZurichMike’s advice: only go on hikes or treks or white water rafting where there is the possibility of helicopter MedEvac services.

    • texan59 says:

      I like thw way you think ZM! 🙂

    • What A Hoot says:

      And some strong libation available to ingest while waiting for that copter.

      • Knight4GFC says:

        I agree with the strong “medicine” definitely. However, this reminds me of a question I have. This question is for anyone who has experience or knowledge on the matter. Perhaps Barn might know about this as he works in the dental world.

        Question: Can Nitrous Oxide be used as a “backwoods” mild anelgesic in a situation where u may need to suture an open wound? Nitrous Oxide, or “laughing gas” is used in the auto world so is pretty much available to anyone. What would be the difference between “medical grade” nitrous oxide, and regular “street grade” NOS?

        • barnslayer says:

          Nitrous oxide in dentistry is just that… NO2. I think hot rodding uses the exact same stuff.
          If you order NO2 from a gas guy (they sell the stuff for torches as well) they don’t ask you what concentration. They just ask what size tank you want.
          The difference is….. oxygen. We use both at the same time with a minimum of 50% O2 (oxygen). Reason being…. if someone breathes just NO2 they aren’t getting any oxygen. They will suffocate and die. If you see the tanks at a dental office you will always see the green O2 and blue NO2 cylinders.

          My only personal experience with getting stitches was on my chin after a wipeout on gravel. I didn’t feel the stitches at all. No anesthetic, shots etc. Matter of fact, my chin was numb for days after.

          • Knight4GFC says:

            Ouch! Thanks for sharing your knowledge on this matter Barn. In a low dose of NOS, could one breathe this in while also breathing regular air? Would one still suffocate? I am not suggesting anything wrong here, just seriously wondering if this is possible for “backwoods” use and how effective it might be.

            • barnslayer says:

              As long as the person is getting air too it should be okay. But if that person is unconscious you won’t know and it’s a waste of NO2 anyway.

              • Knight4GFC says:

                True. I would never use if the person is unconscious. Also, NOS is not a sedative, right? So if you cause unconsciousness administering NOS, you did something wrong.

              • Knight4GFC says:

                How long does NOS take to become effective? How long does it take to come off of the effects of NOS?

              • Just to respond from above, I know nothing about anesthetic use – only a little about use in diving. (Lost my mind here for a sec. Nitrox is totally different – just a N & O2 mixture for diving) In that case, effects don’t seem to be long-lasting. I’m curious, though. Where were you planning on getting nitrous in the woods? Would you carry a can of whipped cream or something like that?

              • Knight4GFC says:

                You can get NOS in small tanks from… like an auto store.

              • No way! You can buy nitrous at auto stores? I guess that makes sense. I’ve never noticed, and I assumed it would be regulated or something, especially here in this increasingly reg-happy bluish state. Maybe not, though. Good to know! Thanks.

              • barnslayer says:

                It wears off in a few minutes. Not sure how long on its own. We always gradually decrease the NO2 until the patient is on 100% O2 at the end.

                It’s definitely not an anesthetic. It doesn’t kill the pain. It just makes it so you don’t care. We usually get the NO2 going and them inject the usual numbing agent.

              • Hmmmm. Maybe Obama’s been on NO2 all this time. Benghazi 3am phone call? Doesn’t care. Goes to Vegas. Killing Bin Laden? Doesn’t care. Playing cards with Reggie. End of the world as we know it? Doesn’t care. Plays more golf. We can only hope that sooner or later he gets his mixture wrong. 👿

  3. I didn’t really expect to get a lot of conversation on this brief and mostly useless post, but since ya’ll are talking and coming up with good stuff, I might add that there seems to be a lot of good simple diagrams for various kinds of suture stiches and knots around the web. Just some examples below. Feel free to add your experience, Barn. As for knots, I tend to go with fishermen’s knots, and I’m not even sure what the preferred tie-off knot is for sutures. For a single, superficial stitch, would that just be a square knot, Barn?




    • Knight4GFC says:

      Cool diagrams! I see a straight needle though. I imagine that a curved needle would make the job easier.

    • barnslayer says:

      Most of what I’m closing is less than 1.5″ long. A few single stitches and I’m done. Continuous stitches are faster but more difficult to control the tension at each point, so I hardly ever continue more than two together. Knotting is a sort of triple slip knot done by taking the needle holder (empty) wrapping the suture material around it a 2-3 times then open the needle holder and grabbing the tail of the suture material. Repeat 2 more times alternating the direction of your wrapping each time. The video shows tying off at the end but they only do it once… gotta do 3x.

  4. Knight4GFC says:

    I gather that NOS would definitely be worth looking into using for backwoods first aid. I might be working on this in the near future… possibly some experimenting. 😀

    So what would be a good backwoods numbing agent? A backwoods anesthetic for situations like these? Its not like everybody just carries morphine shots you know! 😉

    • Knight4GFC says:

      The first two answers don’t count… whiskey and vodka. 😉

      • So…. tequila is out of the question? 😉

        Isn’t there some kind of topical numbing balm available OTC. “Numsident” or something like that? That would be the only thing I could think of.

        • Knight4GFC says:

          😀

          Leave it to Grunt to come up with an experienced answer. 😉

        • Knight4GFC says:

          I’ve never heard of “Numsident” or anything of the numbing balmy stuff before. I’ll definitely look into this. If you ever find something good, let me know Grunt.

          • I’ve never carried anything beyond Ibuprophen before (that helps some with pain but esp swelling). I’ve heard of many folks carrying left-over prescription pain meds into the back-country strictly for accidents and such, but that may technically get you into trouble, since they are narcotics. I’d just as soon avoid them, even if I have the prescription on me, because people traffic in them, so if they’re found during a random police search or something, they can cause you all kinds of trouble. Better to bite bullets and chug whiskey. 🙂

            Of course, I’m biased on that, too. I’m one of those people who are basically immune to pain meds. They just don’t seem to do anything for me. I was in an emergency room one time getting stitched up, and they gave me Valium through the IV, and I swear it had zero effect. The others seem to be just as ineffective, but that could be a matter of dose.

            • barnslayer says:

              If the Rx is in your name (keep it in the original container) it shouldn’t be a big deal. But you want to keep in mind how the Rx or whiskey may decrease your ability to get around.

            • Knight4GFC says:

              I am just like you Grunt! Painkillers, anesthetics, even sedatives have very little to almost no effect on me. For instance, my dentist, during a root canal, became frustrated because I could feel just about everything he was doing! Yes, painfull. He ended up telling me that he shot me up with the maximum amount allowed of whatever he gave to numb me. I ended up dealing with it. He felt bad so he looked into the fact that I was unaffected by his dosage and he told me something like I had more nerves in my jaw than most people and that for some reason, my body would not react with the anesthetic the way its supposed to. I still do not understand all the jargon he told me. On another occasion, I had all wisdom teeth yanked at one time with my brother who had only two yanked. I went in second to my brother and they sedated me. I ended up coming to in the middle of their last extraction. Yeah, not to good of an experience, right? Well, my brother who went in before me, was also sedated. He did not come to till like an hour after my extraction was completed. They were baffled at this and joked that I had come to screaming. I vaguely remember that and all the talking and what exactly they were doing on my last wisdom tooth when I came to. Thankfully, I do not remember the pain.

              I did read that waiting too long after a generous dosage of alcahol can actually thin the blood. That would not be good. But I think that alcahol probably would be the best numbing agent. Just don’t wait too long before doing what you must. Any thoughts on this by Barn would be much appreciated. What do you think of people like Grunt and I who seem to not react to painkillers? What do you think of too much alcohol and the affects on bloody messes?

              • barnslayer says:

                Sometimes you just need to try a different pain pill. Advil works okay on me but Aleve doesn’t do anything. Some say aspirin or even Tylenol works great for them. The stronger stuff (codeine compounds or percocet) may work on you but they aren’t OTC. Regarding your root canal experience… the injection all the way in the back for lower molars is statistically missed 20% of the time by dentists (assuming that’s where you were having the work done). Once the dentist gets an opening to the pulp it’s easy to just inject directly. That works almost 100% of the time though getting to that point can hurt. Some folks are just wired differently than others. Some are hard to get numb and not all anesthetics work the same on everyone. It’s best to know what works for you before putting it in your first aid kit.
                Alcohol’s danger is loss of coordination, dehydration and thermal loss. Increased bleeding shouldn’t be a problem for healthy non-alcoholics.

              • Knight4GFC says:

                Thermal loss. I almost forgot about that! Interesting. Thanks Barn! Dang! This post turned out to be a good one… for me anyways. 🙂

                AND A BIG THANKS TO YOU GRUNT FOR THIS POST! 🙂 Loved it.

              • Thank you guys for the awesome discussion! I loved it! Since we all seem pretty focused on DIY backwoods remedies, any time you guys see something or have an experience you think would be of common interest, post it. Or, if you don’t have time, just post the photo or the anecdote, and I’ll make a post out of it. Thanks again!

        • barnslayer says:

          The majority of dental topical numbing agents are just okay. None will work on regular skin… only on mucosa (inside mouth, nose etc).

          • Knight4GFC says:

            And of course they advise not applying in open wounds, right?

            • barnslayer says:

              I don’t think it would even work.
              Best off sticking to water, hydrogen peroxide (3% OTC at any drug store), chlorhexidine gluconate (~2%) a disinfectant or even bleach (as a last resort). Regarding the bleach, I’m not sure of the dilution factor for the rest of the body as I only use it for root canals. The tissue can get destroyed by this stuff if too strong or too long exposure is allowed.

              • That’s good to know. I don’t know if it’s true, but I’ve read that strong oxidizers, like bleach or hydrogen peroxide, are also a risk for future cancer if you destroy too much tissue, but who knows.

              • barnslayer says:

                H2O2 (hydrogen peroxide) is safe in the OTC concentration. I’ve never heard of any tissue damage with that 3% strength. You can’t beat the price!
                Bleach is a different story. I dilute it to down to 1/5 – 1/10 strength. Even at that dilution you can get tissue burns if left for too long. As a kid I went with my Dad to a medical clinic in Puerto Rico. He cut his foot on some coral. They doused it with full strength Clorox right out of the bottle. I hurt like hell but he didn’t get an infection… ugly scar. Like I said, this is better than nothing but I would dilute it. Cancer is usually from chronic exposure so I wouldn’t worry about it.
                I realize Knight was asking about something to numb a wound but I got nothing except ice.

              • Knight4GFC says:

                Very Interesting Barn! Thanks! 🙂

  5. texan59 says:

    And physiology class begins at 8:00 a.m. in the morning! 😆

  6. barnslayer says:

    Notice******************* to anyone contemplating using automotive NO2 for human consumption…….
    Further investigation indicates the NO2 for cars contains a sulfur compound. It will smell like rotten eggs and will make you sick.
    As far as I’m concerned NO2 is not useful for real medical emergencies and only adds to treatment time.

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