Wound Care

(from scrapes to sutures)

By George E. Dvorchak Jr. M.A., M.D.

SKIN, which covers our body, has the important function of pro

tecting the internal organs and tissues from the environment and

physical objects. Technically, this protective covering is also

our largest body organ and the first line of defense from in

juries and bacteria. With injury, the outer layer of skin, the

epidermis, is either scraped away or opened-up to permit bacteria

and materials to enter. In a more severe wound, the next layer

downward, the dermis is penetrated. This contains connective

tissue, sweat glands, hair follicles, nerves, lymph and blood

vessels. Generally speaking, the deeper the wound, the more

serious the consequences it can have for the body.

As survivalists, you want to be prepared for about anything at

any time. Therefore, the best approach to a presentation on wound

care is to cover everything from the simple closed wound to more

serious injuries. In these, the skin has been compromised and the

wound is therefore referred to as open.

CLOSED WOUND TO THE SKIN: This is the common BRUISE or CONTUSION

which is caused by a blunt object impacting upon the body. The

result is that blood will begin to leak from the injured vessel

under the skin which then causes that area to change color to a

black or blue. The good thing with this injury is that because

the skin has not been broken, infection is not a great possibili

ty. Therefore, the immediate first aid treatment is to apply ice

for about 10 minutes and then throughout the day. Even though the

skin was not broken, this could still be a serious problem, one

depending on what was injured beneath the skin and the amount of

force that originally caused the injury. If an internal organ in

the abdominal area was severely injured, bleeding could be taking

place internally without evidence externally. When traveling or

hunting with horses, an injury could happen by simply stopping to

adjust a load on a pack horse. If he gets spooked and you kicked,

an internal injury could result. A hard kick to the abdomen when

days from medical care could cause internal bleeding that may be

fatal. Not all is obvious at all times!

OPEN WOUNDS TO THE SKIN: It is in this category where everything

from a band-aid to sutures are necessary along with special

considerations and concerns. In beginning with the least serious

of six major categories of open wounds, we have the ABRASION.

This is where the outer surface of skin has been scraped away as

from a scratch or rope burn. There is usually some minor oozing

of blood and serum.

Depending on how the injury was obtained, there is usually dirt

or foreign matter ground into it. This problem brings to light

another player against wound healing, infection. The treatment

now goes beyond the application of ice. To treat an abrasion as a

scraped knee, the wound must first be cleansed with soap, water

and if available, hydrogen peroxide. This will remove dirt that

will cause an infection and therefore impair healing.

Once cleaned, the wound should be blotted dry with a clean cloth

or preferably a sterile gauze. It now would also be a good idea

to apply pressure over the injured site for a few minutes for the

purpose of slowing down and hopefully stopping any bleeding. The

application of a first aid or antibiotic cream to the abrasion

could help to prevent infection and keep the bandage that you

will apply from sticking to the raw wound. For the best protec

tion, the bandage should cover an inch beyond the wound. An ice

pack over the final bandage can serve to reduce swelling and some

of the discomfort. The next category of wounds is the INCISION.

This is made from a sharp knife-like object that leaves a clean

cut. To keep this one separated from the next, think of a surgi

cal incision where the cut edges are smooth.

The third is the LACERATION which is similar but with jagged

edges due to a tear. Because these go beyond the outer layer of

skin and into the deeper layers that contain blood vessels, there

is a lot of bleeding. If you were deep enough or unlucky enough

to cut an artery, blood will squirt out with each heart beat due

to the high pressure in these vessels. The best approach here is

to apply a pressure dressing and get to medical care where su

tures will usually be needed to fully or partially close the

wound, depending on if it was dirty or clean. Because suturing is

a common medical procedure, I will later outline some information

on what is involved to better inform you of your doctor's op

tions.

The next wound is the PUNCTURE. As its name implies, this is

when a foreign object is pushed into the skin. This could be a

splinter that only penetrates the superficial layers of skin or a

nail, sharp stick or fishing hook that penetrates deeper. With

this you usually will not see much external blood which does not

mean that there is little internal bleeding. To treat something

such as a puncture wound to the foot from a nail, all you can do

is to put ice on it along with a pressure wrapping and get to

medical care. This is critical since if you are not already

protected against tetanus, you will need to get an injection for

such protection. If you are in the outdoors a lot, it pays to

keep your immunizations updated.

The next skin wound is the AVULSION. This is where skin is

pulled or torn off. As with an AMPUTATION, the severed tissue

should be saved and taken with you to the hospital. If a finger,

a pressure dressing over the stump or if skin, again a pressure

dressing over the wound is about all one can do until medical

facilities are reached. One other point should be addressed

concerning "serious wound" dressings. That is, once a dressing is

applied, leave it alone and do not take it off every 20 minutes

to check the wound. If unnecessarily disturbed, all you will be

doing is to undo the positive measures already applied.

WOUND MANAGEMENT SUMMARY: The first concern with any wound is to

control bleeding. On the first aid level, this usually means

through the use of a pressure bandage. The next concern is to

prevent wound contamination which refers to cleaning the wound

and applying a sterile bandage and possibly an antibiotic oint

ment. Lastly, immobilization of the inured part along with rest

and if severe, medical intervention, are all wise procedures.

The Mystery Of Sutures - Many of us while growing up had to be

sewn back together. My father, a small town GP who did it all put

six in my leg and another six or seven in my chin all before the

age of 12. If you were like me, you just wanted to get it over

with and therefore could not have cared about details. In the

following, I will give a general summary of what suturing encom

passes. Hopefully, this will help to lift some of that curtain of

mystery concerning this common procedure.

THE SUTURE ITSELF: The thread like material attached to a

curved needle or used on a straight one is absorbable and used

internally or nonabsorbable and used internally and externally as

in holding skin together. Some of the materials used in the

non-absorbables and that which we are concerned with are made

from silk, cotton, nylon, dermal and stainless steel. One of the

reasons for all of the different materials concerns tissue reac

tion to something foreign to the body even though it is serving a

purpose. All the body knows is that there is a foreign substance

within it that was not there before. The body can then react

against this invader and you will get a tissue reaction. The

reason stainless steel is popular in surgery by some surgeons is

that of all the suture materials, it evokes the least tissue

reaction.

Suture size is also important since different materials and

weights of thread are matched to the task and tissue. Generally

speaking, suture material should not be stronger than the tissues

it is expected to hold together. Of all the sutures, those of

silk or nylon are most widely used in holding skin together. The

size is designated as 2-0 or 00, 3-0 or 000, etc. The smaller the

number, the stronger the material. To hold skin together, a 000

or 0000 is generally used. Needles attached to the thread can

either be straight or curved with those curved most commonly used

in your doctor's office. With ones curved, a needle holder or

hemostat is required to use it.

A friend of mine who is an orthopedic surgeon told me that he

would recommend a straight needle for use in the outdoors to

close the skin since a needle holder is not needed. When using a

continuous suture with a straight needle, this would be the

quickest way to close a skin wound. If you are heading into

remote areas and feel that you would like to know how to do this,

I would recommend that you ask your family doctor for advice

since he best knows you and would be the one to advise you on

this. Yet, for most lacerations, a pressure dressing over the

wound would be the preferred procedure until medical care would

be available.

Another consideration your doctor will have to be careful about

is that after skin has been sutured back together, edema or

swelling of the tissues usually enters into the picture. If the

suture was originally tight, with swelling, it will soon be too

tight. Therefore, proper tension the first time the job was done

is critical to good healing.

The purpose of suturing is to pull the tissue together just

enough so that there will be no dead spaces below the skin where

blood and fluid can accumulate. If there is, it will eventually

be a breeding ground for an infection. In staying with how su

tures are put in, it is also important that the same amount of

tissue be included on each side of the suture. If the suture

includes more tissue on one side than the other and/or the needle

is inserted deeper on one side than the other, when tied togeth

er, the skin edges can overlap causing poor wound healing and/or

a scar. All your doctor wants to do is to put the severed edges

back like they were before the accident so that the body can

complete the job of healing.

Because a medical emergency as a laceration can happen anywhere

with the worst place being when medical care is not readily

available, I would highly recommend a Red Cross first aid course.

Once this is completed, I would then recommend that you take

advanced courses and hopefully get certified as an Emergency

Medical Technician. Also, if you go on outfitted back country

hunts, one of the questions you should ask of the outfitter/guide

is if he or she is certified in first aid. In the event that your

guide would get inured, it would also be to everyone's advantage

if you were qualified to help him.

A rule of good medicine is to do no harm to your patient.

Therefore, take a first aid course and learn how to help yourself

and if the situation presents itself someone else.

(This article was optically scanned from :American Survival Guide

January 1992

Subscription Information

American Survival Guide

Subscription Dept.

2145 W. La Palma Ave

Anaheim, CA 92801-1785)