Wound Care & Guidelines when to use Steri Strips for closure or to Suture.
One thing I’ve been wondering is –
Will I be able to actually sew myself back up if something happens that requires that?
I’ve got the suture kits, steri strips, everything to clean the wounds or whatever, but, can I pull off stitching myself up?
That question from a reader here on MSB inspired another (with medical credentials) to answer with some great insight and guidelines. I’ve detailed it as follows:
Steri Strips & Butterfly Stitches
On the strips, there are two kinds. Butterflys and steri-stips.
Steri strips come in 1/8″, 1/4″ & 1/2″ size widths.
I believe butterflys are available in large and small.
Depth of the Wound
The depth of the wound is what matters with strips.
– Less than 3/16″ deep probably okay to use tape (strips).
– Above 1/4″ probably should be sutures.
At 3/16″ it is iffy, tape or suture.
Apply the Strips
With strips consider using tincture of benzoin on the skin next to but not into the wound.
Tincture Of Benzoin, 4 FL.OZ.
Allow it to dry and put the tape on one side and the pull to the other side to close. Start at one end and work towards the other.
Wound closure is done to minimize infection so the sooner the wound is closed the better.
The rule in the ERs that I worked in was get to us within 6 to 12 hours and we might consider closing one that had been left open longer but probably not.
The longer the wound is left open the greater the chance of it becoming infected.
Deep Wounds require special care
Deep wounds need to be closed in layers. If you pull the edges together over a deep wound you might get an abscess under it. I’m not going to describe suture technique as I’m sure there must be thousands of online videos.
Lidocaine & Xylocaine
They are essentially the same and come in 2 strengths.
They may or may not have epinephrine in them.
Epinephrine will reduce the wounds bleeding by constricting the veins and arteries around it. This will also allow the numbness to last longer as the medication is reabsorbed by the body. Circulation is slowed where the epinephrine is.
Fingers, Toes and Nose are never injected with Lidocaine with Epi. Damage to tissue from lack of circulation in those places could lead to amputation.
Wound Healing by Granulation
If a wound can’t be sutured it heals by granulation. It will slowly fill in from the bottom up.
At least daily dressing changes will need to be done and the wound cleansed & observed for signs of infection.
Not all wounds need to be closed with Lidocaine. First, lidocaine burns like crap when you’re injecting it and you have to inject it numerous times around the edge of the wound, When I was in Vietnam and going to sew some dude up I’d give them a choice. Most would not opt for the stuff that stings.
I had an incident where I was building a shed and walked into a corner of the metal roof. I needed stitches and at the time I was without insurance. I did have the equipment so I sewed myself shut in the bathroom mirror. It was kind of difficult as all the moves were backwards in the mirror. No lidocaine and the discomfort was only moderate, I expected more pain when I pulled the suture through the skin but it wasn’t bad at all.
Steri Strips Removal
When removing steri-strips pull one side to middle of the cut. Then pull the other side to th middle. Then pull both sides up.
Wounds take months to heal completely. Pulling the tape from one side over the wound and continuing to pull could pull the wound open.
For best results when removing steri-strips and sutures remove every other one. If the area of the wound is looking like it wants to open, leave the remaining ones in place for another day or two.
How Long to leave Sutures intact?
I liked to leave sutures in scalp wounds for 5 t0 7 days.
Facial wounds, 7 to 10 days. Most other wounds 10 days to 2 weeks.
The more a part bends the longer you need to leave them in. A cut in the middle of the forearm is going to get less bend than a cut on the top of your wrist would be an example.
Staples, Super glue, and Fishing Line
Medical staples are also used and can be had for preppers. I believe Doom and Bloom sells them.
Super glue can also be used for minor wounds but you really should use the medical grade.
2 or 4# mono fishing line can be used as a suture material if nothing medical is available but it must be sterilized.
Clean, Clean, Clean!
Lastly, you need to be as clean as possible when you are doing surgery and suturing is surgery.
The wound needs to be scrubbed and the suture must not be allowed to drag over dirty stuff like the patients clothing.
Consider draping the wound with a piece of plastic sheeting with a hole in the plastic where the wound is. Then spray the plastic with a disinfecting solution.
If you see pus coming out of a wound that has been closed it is time to go to the doctor and if there is no doctor remove the sutures, treat for infection and allow to heal by granulation.
Hope this was helpful and remember doing this to others is practicing medicine without a license and you could get in trouble for so doing. Therefore this is not medical advice. Just stating opinion from experience.
[Ken adds:] You do have a general purpose First Aid Kit at home, right?
Coleman First Aid Kit, 205-Pieces