BACK TO THE SUTURE

Traumatic injuries occur in the tens of millions every year in the United States. According to the Centers for Disease Control and Prevention (CDC), close to 2-million victims of trauma require hospitalization annually. In normal times, trauma victims have the benefit of an infrastructure that allows rapid stabilization and transport to a modern medical facility. The off-grid medic, however, has no such access, but is even more likely to be confronted by traumatic injuries.

In survival scenarios, mishaps related to activities of daily survival are bound to occur. Those unaccustomed to, say, chopping wood for fuel could easily end up requiring intervention by someone with medical skills in the event of an accident.

One of those skills is wound closure. The well-rounded medic should be familiar with the various methods and materials used in closing a laceration. More important still is the proper judgement as to when an open wound should be closed and when it should not. Having the necessary knowledge, training, and equipment is imperative to be an effective caregiver.

The Open Wound

An open wound is any injury that breaches the skin. Skin is your natural armor. It prevents the invasion of microbes into the body that could otherwise be lifethreatening. Typical open wounds include:

Abrasions: An abrasion occurs when your skin rubs or scrapes against a rough or hard surface. A motorcyclist’s “road rash” is one example, but most people have “skinned” their knee as children. Bleeding is minimal, but the wound needs to be scrubbed and cleaned to avoid infection. No closure is necessary.

Punctures: A puncture wound is a hole created by a projectile, nail, needle, or certain animal bites. Some punctures may not visibly bleed, but can be deep enough to damage internal organs and increase the risk of infection if closed.

Lacerations: For the purposes of this article, we’ll define a laceration as a cut that goes through both the upper layer (epidermis) and the lower layer (dermis) of the skin. Skin lacerations expose the structures underneath to the risk of contamination. Accidents with knives, tools, and machinery may cause lacerations that slice through major blood vessels or even cut deeply into internal organs, like the liver. Bleeding can be extensive. Most lacerations these days are closed by a medical professional.

An avulsion is a tearing away of skin and the soft tissue beneath. Avulsions usually occur during violent accidents, such as crush injuries or shrapnel wounds. Degloving is another gruesome form of avulsion (don’t Google that unless you have