I know this is a little extreme and I am surely not a "Rambo" wannabe but, does anyone have a suture kit? Recently my bird dog received sutures on his leg and I watched as the vet did the "sewing." It was rather simple and I thought that if your buddy had a real bad gash that required a little more than a few butterfly bandaids that it wouldn't be all that difficult. I found some sutures on the net and was wondering if anyone had an internet source for med supplies that they liked.

Mark

Super glue and butterflies are always in my kit...

I keep a pretty complete minor surgery and medical kit in my truck. In my "survival kit" in my main pack I do have a couple sterilized instruments and some suture.

I guess this begs the question of what size of a cut is too long/big for butterfly's and superglue?

Mark

When I was little I watched my Grandad sew himself up with a fishook and line after numbing his hand in the icefishing hole. I'm not sure what pound test it was, but I'm guessing there are probably better ways to close a laceration.

If you have any friends in the Nat'l Guard their medics can usually get their hands on the real stuff.

SD

I'm not a doctor but I do have medical training as a respiratory therapist and I work in the ER and ICU. One thing to consider about suturing up a laceration is your ability to clean out the wound first. If you suture shut a dirty wound you are just asking for a serious infection that can spread to the bloodstream if you do not get medical attention for several days (such as getting a bad cut on the first day of a weeklong pack in hunt).

It is better to leave a cut open and put clean bandages on it, pressure if necessary to stop bleeding. If it is bad enough to require immediate suturing, you need to make an effort to get to a hospital. Just a little advice; I had thought about the suture kit myself before.

I put a couple dental floss sutures in my leg about 20 years ago. I was geeting an elk out and fell on some sharp shale. Did the trick. About tens years later I did a head plant into a ski tip and layed open my eye lid. It was a bit*h skiing off the mountain with blood running into my eye. When I got back to the cabin my wife patched me up with butterfly's. She wanted to take me into the ER for some sutures but that was the last place I wanted to be on new Year's Eve, not to mention the 2 hour drive.

All in all, I thing the butterfly's, siper glue and duct tape are the best bet. The risk of infection is greater with sutures.

I also patched up my lab's sliced leg with a surgical stapler. This is probably the safest option if the glue, butterfly's etc. aren't enough.

Ed T

Mr. MarlinMark:
As one who has had the dubious distinction of having some stitches put in without freezing, I can�t say I recommend the practice, cause it isn't pleasant.

I am an Occupational First Aid attendant at work, and we use a product called Steri-Strips if we can get them, as opposed to the Johnsons� Butterfly bandage, as the Steri-Strips stick better. We�ve found that a product called �Friar�s Balsam� helps any self adhering bandage to stick better, especially on hands which can sweat Butterflys off in short order sometimes.

You asked about what requires stitches. For us, any laceration that is 1� or more long or is across a joint, like a knuckle and is �full thickness of skin� that is through the layers, requires us to ship the injured worker to Emergency for stitches. The most important thing is to really clean out the wound before suturing, and that can hurt more than the stitches. Yes, again the banged up voice of experience here. We use sterile water for cleaning out the wound, but I�ve had Emergency nurses use sterile water and a scrub brush on me��

While I do carry a suture kit that a friend got from the local OR, I pray never to have to use it on myself. Good on you for thinking ahead though.

All the best,
Dwayne

Excellent replies, thank you all.

BC30Cal- I will look into stocking my kit with Steri-Strips and check out the Friar's balsam as well.

Keep the replies coming. I think this is a topic that we all can learn from experience.

Mark

gives me the shudders. my best pard added one to his kit back when we were guiding together, azzwipe had new toy syndrome to the max.

all he could talk about in the tent at night was how he was ready to stitch me up should I get cut open!

I got sorely tempted to run a knife blade across his thigh, so he could get it outa his system.

He finally got over it, if it's still in his kit he doesn't mention it.

But we each have a med first aid kit that has the stapler in it now.

But like Cooper said bout $700 and a 30-06, there ain't much super glue, duct tape and antibiotics won't fix.

Thought I should chime in as well. I am a doc, and I can tell you that for most wounds suffered in the field, the best way to treat them is to irrigate them out, leave them open, and apply a clean bandage, replacing when necessary. Very few wounds truly require closure, unless you are concerned about a scar. In the field, the main concern is infection, as mentioned above, and as one of my old vietnam era surgical professors used to say, the surest way to get a wound infected is to close it. This allows the bacteria a closed space to fester.

If you were to carry anything for wound treatment, I would recommend pressure bandages with gauze, and ace wraps to cover the dressing, and keep clean. A filter or iodine tablets for clean water, and a splint for extramity wounds.

Steri-strips, friars and a pressure dressing are the way to go. Was a medic for 26 years in the CF. If we sutured somebody in the bush, then they required antibiotics. Plus the need to freeze prior to sewing, just too many variables there. If it is a deep enough laceration to suture there are tendons and ligaments that could be involved, esp on the hands which is most likely where a hunter/fisherman is going to cut themselves. Even closing a wound with steri-strips probably needs to be seen by an ER, but at least you can't screw up the steri-strips.

Great info. I like the idea of just irigating and dressing. I sure don't want to close something up and have a greater chance of making it worse than better. I'll carry some steri strips and the friars.

So, the friar's is applied to the area that you want the steri strips to stick to? It aids in keeping them stuck? Do I have that right?

Mark

I have carried Steri-Strips for many years, on advice from "the Cherub" a former outpost nurse in the Yukon and NWT, whom happens to be married to me. I have occupational first-aid training and also carry gauze pads, Tensors, and duct tape which can close any wound I get and with pressure, I can control haemorrage as well.

I had 12 stitches put in my scalp when I rolled my car into the local police station as a youth, no big deal, it hurts, but, isn't in the league of kidney stones whcih make even a broken leg seem mellow. My objection to this IS potential infection and that is far more frightening in remote wilderness than scarring or an open,,clean wound.

I think that a simple approach to bush first aid is best, overall and have two kits which cover everything. Strong painkillers are more useful than a suture kit and extra Telfa pads and big heel bandages are what I seem to use most.

Kutenay

If you are blessed with kidney stones like I am, you've learned that the actual pain of them is tolerable as it comes in cycles. What is not tolerable to me is the muscle contractions.
I hope you always carry meds for both muscle relaxants and pain relief.
I do not always have them on all my "local" trips, where I'm accessed to the hospital, but if I leave on foot, I always have 2 bottles...

You got my PM I assume.

Jeff

Yup, sorry I forgot to reply, trust the parcel of goodies will be satisfactory.

Nope, had them once, toughed it out for a couple weeks and then had the old-fashioned method used to remove them, very nasty and worse than most of the seven fractures I have had.

The Friars is "painted" on the area you want anchor the steri-strips. Let it dry to a tacky consistancy, happens pretty quick so no big deal, put one end of the steri-strip on across the wound and pull it tightly across and put that end on the skin on the otherside. Try to line up the edges of the wound, helps it to heal if that is all you plan to do, but more importantly, by lining up the wound edges, it will help keep it clean, thus minimizing the chance of infection even more. Oh yeah, don't forget to get a tetanus shot. I usually make sure I am up to date yearly. ANY doubts about the wound, see a doctor!
FWIW, I carry 1/4" and 1/2" wide steri-strips in my kit, friars, telfa, pressure dressings and tape. Elasto plast dressings in the wider sizes can double as both the dressing and the tape.

I do not carry suture supplies or a stapler but I do have compression bandages (bloodsuckers),traumadex (which is another version of quick clot) and dermabond (sterile superglue). If a cut is that bad in the field I am far more concerned with blood loss and shock than scaring and keeping the wound clean.

I do have a couple percocet or demerol in the pack as well (my Dad has Kidney stones).

Mr. troutfly:
This is a quick thanks to you and Mr. bert12 for clarifying what I was trying to say and completing my thoughts for me. I shouldn�t post when I�m tired��

Mr. MarlinMark:
Please read the replies by Mr. Troutfly and Mr. bert12 carefully and follow them. In my experience, they are both correct.

Here at work, we�ve had serious infections come up so quickly, I wouldn�t have believed it if I hadn�t seen it. The next time it won�t and it appears to be a much worse injury. It seems to me to depend on the individual�s overall health as well, but I don�t really know. What I�m saying is that just because buddy survived �this or that� and got away with treating it �this way�, does not guarantee you or even he would be so lucky next time.

I�m trying to encourage you to follow Mr. troutfly�s advice in that if a wound is bad enough that you need sutures or even a couple Steri-Strips, you�re likely best to be heading back to the truck and then to professional medical help.

Again, my thanks to the experts for their very good input and here�s hoping none of us need the First Aid kits we pack!

Regards,
Dwayne

Rather than sutures, butterflies or strips, superglue, duct tape, and direct pressure. If it's really bad, get out asap.

Have you taken a good first aid class?

My dogyard has gone through several periods where the dominance hierarchy shifts and that is always accompanied by gashes and deep puncture wounds. I used to irrigate with a 100 mL syringe (without needle) and 5-10% povidone iodine and then pack the wound with one application of nitrofurazone. I have also, in a pinch, just packed it with the nitrofurazone without irrigating. I have never seen an infection set in after using that stuff. I would be tempted to use it on myself in the field, although it is not for human use. You get nitrofurazone at the feed store.

My reasoning for not staking the dogs separately at home is that I'd rather them work out their differences at home than on the trail.

BC30Cal- I apprecieate your comments and am planning on adding the suggested supplies to my kit.

Ironbender- I've had many first aid classes as they have always been required by my different employers over the years.

Thanks to all for your input. It is good to plan ahead and not need it rather than the alternative.

Mark

i used to carry sutures and syill have pletny of access to them, but like said above without adequate numbing its not any fun. I carry steri strips and have the extra adhesive that is applid to the skin to help it stick better as well as dermabond which is essentially medical grade super glue. if super gluing a laceration always make sure it is really clean and always leave a small opening ( 1/8" or so)at the end to promote drainage of anything. I have only had to glue myself up once and had the opportunity to saok it nightly and never had any problems, just covered it while hunting during the day

A few years ago,I cut myself gutting an elk. Back at camp I had 2# fishing line and some big needles for sewing up livestock which prove to be very dull. I put 4 stitches in my hand without any deadening except Jack Daniels inside and out. The pain isn't a bad as seeing your blood leaking out
Get your doctor to write a scrpit for a half dozen and then you can by suture kits at any medical supply house. We have two here in Colorado Springs.

I carry them now and I have a BIG first aid kit.

A second option is to get a few hypodermic needles that 2# fishing line will slide through. The hypodermics will poke through pretty easily and you can then feed the line through, pull the needle out and tie off. If you can't get it sewed within 4-6 hours, it probably won't do you any good

Buy a bottle of Providine or Iodine wash from some livestock supply company. Infection is about the most dangerous problem you will have.

As for kidney stones I now carry a few Dilaudid, Motrin and muscle tranquilzers. They all work in different ways according to the Emergency Room doc and you can take them all at once to releive the pain enough to get to the hopsital I haven't tried it yet as I have been stone free for 11 months now

SS,

You're a tough ole hombre! (grin)

Happy Thanksgiving,

MtnHtr

+1 on that, unless its gushing out I would rather watch it bleed...

You can be a tough hombre, just be smart.

Fishing line is asking for infection, and tears skin easily.

I sewed a buddy up with fishing line. He insisted and then thought I did such a fine job he did not go to the doc after we returned to civilization. The cut was roughly 1.5" long in the heel of his palm, and I treated with peroxide while I stitched.

He is one damn tough dude. Or was until an infection set in and he waited to go to the ER. And waited. He almost lost his hand and was hospitalized for 2 weeks before she was all said and done.

The sight of his hand opened up like a suitcase to drain put the fear of the big man upstairs in me.

Thanks for the tips, I'll include them in my pack. Follow the doc's advice, and take infection seriously.

Peroxide is not a good disenfectant. That is why I mentioned the provodine/iodine.
I have sewed up quite few horses with fishing line . It works fine, IF you watch the site for infetcion. Note that I stated infection was the biggest problem. In an emergebcy, you use what you have on hand. Note, I have suture kits now. Years ago you could not get them.

I am a physician, and I've gone on several one to two week hunting trips, and I've obsessed over every single shred of gear I carried on my back. With that said, on the last trip I had the following:
1. Vial of local anesthesia with appropriate syringes
2. Nylon suture swaged on a straight needle (Keith), not needing instruments to suture
3. Povodine-Iodine swabs,
4. Bandage material
5. Oral Antibiotics/Pain Meds/Allergy meds/eye drops
6. Toradol injectible (non narcotic analgesia)
8. Sterile Gloves
9. Derma-bond (sterile superglue)
10. Duct tape (a myriad of uses)
Thank God, I've never had to use anything beyond the bandages/duct tape on foot issues. I'm not proposing everyone needs all this stuff, but they are my tools of the trade, and I like to have the option of using them.
Back when I had my trauma training, we weren't allowed to suture any wound older than 12 hours for fear of infection, and we would let it heal by "secondary intention". Actually we were so 24/7 busy that when a wound came in 12 hours old, we jumped for joy and put a nurse on debridement/cleanup and on to the next!. The 12 hour rule was flexible though, depending on the location and condition of the wound. Now that I specialize in the Head/Neck, I would close just about anything that I could clean properly. Antibiotics and great regional blood flow (plus cosmetic considerations) make this possible in this area.
Don

docbd.
How can I get some Toradol? When I go to the ER for kidney stone. They give me Duladid (sp)and Toradol. One alone won't do it. But they always have to check for kidney function before I get the toradol whcih is sometimes a nhour or so. That is a long hour.

Our kits contain about the samething .Got the local anesthesia from a neighbor doctor

Saddlesore you need a prescription.

Saddlesore,
I think you would need to get a vial from an MD (my Anesthesia Dept. uses it alot as an immediate post operative pain reliever, and it's impressive). As SubDoc said, it's perscription only. Good point on the kidney function, also! A kidney stone must be a crusher if Dilaudid won't do it alone. When my disk herniated back in '04 (cervicle), I got a shot of Dilaudid in the ER, and lights out!

docdb-

How do you use the dermabond? Do you apply it and then use butterflies or steri-strips (not listed in your kit) to hold the wound open so that the glue gan set?

Thanks,

Mark

I've only used it in surgery, and there, approximate the wound edges usually with a well placed deeper layer of suture. This wouldn't be possible in the field, so I think you would rely on the glue to fill the wound. Obviously, if bleeding is brisk, the glue won't work. I neglected to mention the steristrips (and benzoin, a skin adhesive).
Don

I've thought through the possibilities also being an anesthetist but as docdb mentioned, space and weight, are always critical.

I have however settled on some benzoin-alcohol skin preps with Super Glue, two rolls of elastic bandages, Torodol, as mentioned and one other product you may find interesting which I carry on big game trips and while bird hunting.

I figure the little cuts etc. will have to take care of themselves; it's the big, open wound from whatever cause that may be life-threatening for which I carry a product called Quickclot by Z-medica (www.z-medica.com) It's a 3.5 oz packet that is an adsorbant hemostatic agent. It simpley pulls water of the plasma to itself allowing the clotting factors, platelets, etc to concentrate initiating rapid clotting even in hemorragic situations. The research on this product has been interesting and dramatic to say the least. One of the surgeons I work with and who is also an outdoor type says he wouldh't hesitate to use it even in the ER should the "right" circumsances occur - it's not on most hospital formularies as it's niche is most certainly emergency situations and thus may be found in some ambulances. It's a 1-2-3- step process and just may save someone's or your dogs life.

Check out the website; they used to have some of the research their and anecdotal info that was very interesting.

Gdv

Saddlesore-

In anesthesia, we use Toradol (ketorolac) by the gallon, literally, in a years time; it's one of the most dramatic and effective non-narcotic analgesic going and I can speak from personal experience too.

Gdv

I use the glue alot too, mostly cosmetically. It won't close a "wet" or bleeding wound very well or hold on a deep one alone. It mostly replaces the simple interrupted sutures on smaller incisions after a deep cuticular layer is in place. It does work great for paper cuts and dry skin cracks though

www.redflarekits.com

While were on the subject does anyone have any other online suppliers for the equipment? I found redflare on a search and have been pretty happy with their service so far.

Also is anyone else using a coagulant such as quick clot or traumadex?

Super glue and duct tape accompany me.

Quick clot is a great idea for sure.

I also carry steri-strips.

If I have my dog with me, which I always do, I have a sterile disposable stapler and iodine wash with me.
The stapler has saved the day more than once, and not just for dogs either.
I get the little 30 staple ones from a Vet supply online. I give them out as gifts to friends with gundogs.

steri-strips for me,they work for sure.

Do you ever wonder why/how an 8 year old thread suddenly becomes "new" again? Wonder how many of the doctor wannabee's have sewed themselves shut since 2007?

Back when I was a caver (early 80's) I was trying to learn what sort of first aid might required. I had a buddy who'd been a medic in Nam, and he taught me the crude rudiments. Caving is bad, because you have to deal with 100% humidity, and endless mud and water-- kind of like a jungle only colder. When it got to dressings, suturing, and such, he said absolutely positively not. There was no way to insure there was not foreign material in the wound and closing it up could be a death sentence. The idea was to keep it open and clean until it could be dealt with in a sterile environment. I threw out the suture kit I had.

A few years later I was on a tubing trip unrelated to the caves and fell and managed to sit down hard on my left hand. I was okay, but I had a small nick on my left thumb. It stayed in the river water all afternoon, and I tended to it when I got home with the best I had from my kit. It healed in 3 days. Day 4 was no problem. On day 5 it went septic and I nearly lost the thumb. I'd been so good at getting the skin to heal over, and left some imperceptible piece of river muck down near the bone.

Neosporin and bandaids.

I also carry a small bottle of "liquid bandage" but have scars from large "repairs."

The liquid bandage stuff has anti-bacterial in it.

QuickClot is fine for life threatening events (I have some on my motorcycle), but not to be used unless you plan on losing the surrounding skin.

BTDT.

Similar to mine. Toradol is magic!

Provodine/iodine and a large syringe, without the needle.

Mix the povodine/iodine with water in your cook pot and use the syringe to irrigate the wound.

Several years ago I read a pretty good article on backcountry first aid, written by an ER/trauma doc who also served on search and rescue teams. When discussing backcountry first aid kids, he opined that you can makeshift just about anything, but that wound irrigation and splints were difficult (more difficult in the field than in your typical first aid class), and recommended a SAM splint and tape (duct or med) along with the irrigation tools mentioned.

For use in a small first aid/survival kit, Potassium Permanganate crystals be a good alternative also...

Steri-strips here, as well. I've also recently added a small baggie of corn starch - I've seen it clot up some wounds that really didn't want to stop bleeding.

FC

Read "Wilderness Medicine" by William D. Forgey, MD. ISBN 978-0-7627-8070-9. Lots of good advice with suggested medical kits with multiple use items.

Great book. As with many skills training trumps gear.

Suturing is easy, proper assesment and cleaning not so much.

First, Do no Harm.


mike r

Yeah it's the humidity and mud that are bad about caving.

How about the DANG CAVE!

For skin wounds a product called Leukostrip by Smith&Nephew is better and more water repellant than the butterfly's and the Steri-Strips... if its deep enough for stitches or staples, forget it clean it, clean it bandage it and get to the local doctor. Deepwound infections just aren't worth it.

keep a little alcohol, betadine, antibiotic salve, leukostrips, gauze pads, and tape. Band-aids are about useless.

Phil

I keep one in my fishing bag with bottol of oragel and a rube of styptic powder.
The oragel will numb the site long enough to throw a few stitches then I can stop bleeding with the powder.