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?
In 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.
Let 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.