Scenario - Serious gaping wound and medical help is days away at best. What’s the procedure for stitching someone (or yourself) up with household supplies and a home sewing kit?
What knots do you use? Thick or thin thread? How do you numb the “sewee” (or do you)? What are the prepartions? How to disinfect tools? Do you need a curved needle?
Depends, as long as there arent any blood vessels or nerves that nee to be connected, and you dont tissue match because you dont mind the scarring [yopu know, submucosa to submucosa, mucosa to mucosa…doctor-y schtick] I would go with a basic sewing needle, and sterilized silk embroidery floss [in white preferably, sye can come off and stain the skin]
Rather than whipstitching it together :eek: have the person helping you [if you decide you are lucky and have one] forget any kind of painkiller, unlike someone like me who used to vet my larger animals myself you wont have lidocaine, suture its and a syringe for the lido 
You hold the flesh together, and your helper stitch the wound closed one spot at a time, using a surgeons knot and start the trek to get to a real doctor…
Though if you were in the amazon you could use the ant pincer thing they do there=)
Take a course in emergency first aid, or wilderness first aid if you specifically expect to be without any supplies whatsoever (not that you should ever be out in the wilderness without a first aid kit).
That said, the important objectives are to control bleeding, prevent the onset of shock, and prevent any further complications as a result of the wound (infection, sustaining further injury, etc.) Essentially, what you do in these cases is the best approximation of the same care you would give such a wound if you had all the proper supplies - you just might need to improvise a bit with whatever is at hand.
To control bleeding, the first thing to do is apply firm pressure to the wound. Do this with your hand over a dressing, or if you don’t have any sterile dressings - improvise. Tear up your clothes to make what you need. Fleece clothing is actually great for this since its low absorbency prevents it from sticking to the wound. If direct pressure controls the bleed, tie off the dressing and make your way to help. If direct pressure does not control the bleed, you may need to apply indirect pressure - this is a bit beyond explanation on a message board. Take a course, or do some reading. In extreme cases, you may need to apply a tourniquet to reduce blood flow to the afflicted area - generally, if it is this bad it is not entirely feasable that you would treat yourself and make it to medical help which is days away. YMMV.
With severe lacerations, you can actually use duct tape as a skin closure, while applying pressure, and then dressing it. Simple band-aids will also work as temporary “stitches” underneath a dressing to keep a gaping wound closed. I wouldn’t suggest sewing a wound closed yourself, since the potential for secondary infection is so high, but it’s your call - if you are a long time from assistance, and there are no better means available of managing the wound, then go for it. Life before limb, and you have to do what you have to do.
Self-administered first aid is very much common sense. Don’t think of it in terms of what specifically needs to be done for any given wound. Rather, identify the key objectives (clear airway, effective breathing, maintain circulation, control bleeding, prevent shock), and do the best you can with whatever means you have available to meet those objectives.
Afterthought: Just wondering what scenario you envision in which you have no first-aid supplies, but do happen to have a sewing kit?
I can attest, having received home-made stiches when I was about 5, that it is very possible a horrific scar awaits you if you try stitching without the skills and equipment of a doctor.
Dude, I always have sewing stuff. I keep reminding myself to get a first aid kit and never do.
On the other hand, better hope it’s not the cross-stitch I’m working on at the time, as a tapestry needle is, eek, rather unsuitable.
While I’d opt for steri-strips or butterflies, if I had to, I’d opt for a curved upholstery needle and do a continuous looping stitch. After all, the goal is to preclude hemorrhage, until transport is available. Infection? Feh. That’s why we have keflex.
Having worked in an ER, I learned that infections can be cured, dead can’t. 
First, you probably don’t need to do it. As has been pointed out, stopping bleeding is the priority, and that rarely requires sutures. Tape will do far better for you in a pinch.
But if you feel you absolutely must, well;
If you have benadryl (diphenhydramine) liquid or capsules, you can dump this into the wound to numb it some.
Interrupted sutures would be best. If the thread breaks, the whole thing won’t unravel.
Don’t do layers, as your suture material probably won’t be absorbable.
Square knots are best to tie each one off with. Don’t Granny 'em!!
Just concentrate on closing the wound, don’t worry about making it neat.
If the wound is from an animal bite, think twice about suturing. A closed wound with a bite infection gets nasty really really fast, and often fatally. An open wound can at least drain.
And finally, you really shouldn’t do it unless there’s no other choice. And there’s almost always another choice.
QtM, who hasn’t sewn anybody up in nearly 2 and a half days (I had Friday off).
For the life of me, I couldn’t help but picture astro holding a bloody hand in the air as he peers at his computer monitor, saying, “c’mon, somebody answer this !@#% thread, I'm getting blood all over the !@#% keyboard!.”
You know, I can’t sew worth a crap and I rarely, if ever have a sewing kit with me, but I often have a bottle of superglue handy…
Are cyanoacrylate adhesives ever appropriate in an emergency situation?
I really don’t think so. I can’t think of a life or limb threatening wound that I’d want to try to glue shut. The glue is convenient as hell for nice, neat lacerations that come together with a little bit of traction. Otherwise, I gotta drag out the damn suture equipment, tie up the treatment room for 20+ minutes, and get myself further behind schedule.
Duct tape. That’s the emergency answer. That and 911.
Now duct tape I can do! Thanks, doc.
I personally know of one person who got stitches in the outdoors. Considering the circumstances, I’m not sure why they just didn’t drive him into the nearest town (then again, I’m not sure how far it would’ve been to a city with a hospital, perhaps as far as Santa Fe), but it was done by a RN. No anesthesia, of course. Probably not even any alcohol (to drink, not to use on the wound.)
I wouldn’t want to do it to either myself or someone else. I’d much rather see if I could stop any bleeding first by using direct pressure and a tight bandage, and then look into a tourniquet released frequently before I start trying to stitch someone up. I can’t even hem my pants or put a button back on my shirt.
I say this half jokingly, but with complete sincerity: alcohol will disinfect a wound.
I’m not propositioning that you dump a fifth of vodka on your papercut after throwing a log on the fire, but it is a well known fact that alcohol applied to a wound has a tendency to disinfect the wound and help it heal.*
So put that damned bottle-‘o’-Jack down, and let your buddy take a swig before you stitch him up with dental floss.
Yes, dental floss does miracles for suitures. I can attest to this more than the bottle of Jack.
Tripler
Field medicine is more an art than a science.
I’m not sure that disinfect is the right word. Disinfect is different from sanitize. I suspect that sanitize is closer in meaning to what you’re talking about.
That said, the antiseptic properties of alcohol come from creating an osmotic imbalance. The tiny bugs explode (or is it implode?), So the proof of the alcohol is a crucial factor in the efeciveness of the booze. It’s not the case that the higher the better. There’s an optimum level ( ≈70% IIRC)
see this previous thread: How strong should my drink be before I dump into an open wound?
However, whatever you’ve mixed your drink with should have an impact on this as the action is a matter of creating an osmotic imbalance that swells, (and bursts?), the bacteria. Additional solutes, (flavorings, mixers etc), would alter the ability of your drink to perform as an antiseptic, (prob’ly for the worse).
PGA w/ (distilled?) water would be the ideal antiseptic drink. It lacks the drinkability of just about every other drink that I can think of, though.
Not to mention pretty hard for most folks to come by. Everclear’s close, but who drinks that once they’ve graduated?
I think I’d go for clean water, honey and duct tape. (Hey, what sort of savage goes wilderness hiking without a honeybear for his tea? 
) And an appointment with QtM ASAP!
Question: would it be better to rip the duct tape into strips and leave a little space between each strip for drainage/air flow, or should the wound be covered completely by a large strip of duct tape? I’d be afraid of setting up an abcess situation if the duct tape covered the whole thing, but IANAD.
My father the stoic once stitched himself up. I had to hold the sewing kit (I think I was about 10). He refused to turn the boat around after gashing his head open on the boom. About a week later (still on the boat), he took the stitches out. Ick! He kept it scrupulously clean, with honey on it, and there was no infection and very little scarring. YMMV.
(This is also the man who left a broken arm untreated for weeks as a teenager so he wouldn’t have to tell his mom he’d been playing football. Ended up keeping him out of West Point, so I’m not sure he’s the best role model for medical treatment.)
I defer to the real doctors, but I’ll add some things.
The wound should be washed and sanitized as well as possible. In the ER, this means using pressurized saline to get the crap out, then flooding with Betadine and letting it dry. I would almost rather see a wound covered and kept clean and open than closed in a non-sterile environment. The body knows how to heal a clean wound by secondary intention, that is scarring and granulating over. It’s not pretty, it takes a while, but you’ll live.
If you seal it up without cleaning it well, you may have a much bigger problem. What happens is anaerobes, which have a particular fondness for soil and just about everything dirty, just love it when you seal them nice and tight in a pocket of tissue without access to the toxic oxygen. They go and form nice big abscesses and can cause things like gas gangrene and all kinds of great wound infections. This makes your problem worse, as septicemia is much worse than a cut and abscesses require incision and draining and then being left open to granulate (so you end up with a bigger scar).
Don’t close animal bites. Human bites are even worse. The typical thing is the guy coming in after a barfight with gashes on his knuckles from punching someone in the teeth. Because the cuts are on the knucles, they appear larger than they really are. We wash it out, give him some topical triple antibiotic cream, cover it, and send him home. He invariably bitches that he needs stitiches.
The other thing that people don’t know until they go through medical school is that the main purpose of sutures is not to close a gaping wound. It is to approximate the skin on the surface of a wound to promote healing by primary intent. Sutures that pull the skin often lead to bigger scars than expected. Subcutaneous and dermal absorbable sutures are used to pull the fascia closer together to get the skin in a position to pull it together with surface sutures.
In the clinic, we usually used monofilament sutures for superficial wounds. So think very fine fishing line. It is easier to sterilize also, as it is nonabsorbent. As QtM said, interrupted box stitches. Don’t seal it too tightly, leave a bit of play in the loops. Tie the tops with square knots in opposite orientations (tie one left then the next one right).
It would be a good idea to have boiling water and a curved needle and plastic thread. The plastic thread can be bought at any fabric store, and maybe WalMart. It’s usually called invisible thread, it looks black though and it’s plastic thread, like real sutures. Ice would be nice to help freeze the top where the needle will puncture the tissues and skin. But the water that made the ice should be sterile. Alcoholwould be a good thing to have too. And what may be helpful only for external skin would be the liquid bandage sold in stores. Otherwise get to a Medical Facility quick!!
Once upon a time while camping I was helping to saw logs for the fire. I was holding, and someone else was sawing. The saw jumped out of the groove and sliced across my right index finger between the knuckle and the next joint.
Oooo! Neat! look at all the layers…!
Well, there a lot of screaming and hollering following that, most of it not mine. The scout leader already had some boiling water available, let it cool down, then sat me down and used about a gallon of it to wash the cut out. It was bloody, but no spurting and I didn’t feel faint or anything…
Anyhow, there was a lively debate about stitching me up and offerings of sewing kits, but the woman in charge said no, we’re not going to do that. After the wound was clean she lined up the edges of skin and put on a firm but not squeezy-tight bandage. And that’s what I had until we got back to civilization.
Well, mom freaks and takes me to a doctor. And the doc says… “Hmmm… no infection… wound is closed… yeah, it’s a bad cut and I might have stitched it when it happened, but no need to do so now, it’s already half-healed”. So, no stitches. And almost no scar – you wouldn’t notice it unless I point it out, and even then it’s hard to see. Then again, I was young and I don’t scar much anyhow.
So, methinks keeping the wound clean to prevent infection is probably the most important thing. The stiches can pull the edges together, but so can other means.
Having had an abcess later in life that did require surgery, I think I’d prefer to keep a wound open, clean, drained, and uninfected and ask a plastic surgeon to “revise” the resulting scar later than to sew it up and have an abcess form - particularly if I’m away from modern medical care.
When my third degree tear (right on the centerline) was being sewed up, my OB was instructing the younger doctor. He was doing a question and answer session about the stitching. He chose what seemed like a whip stich and did not tie the knots between each stitch. He said that in this case it was important not to stop blood flow in the tissue at all. The edges of the wound would tend to close anyway in that area, that you just need to make sure it is lined up and closed, but that ripping or popping the sutures was not a concern as much as letting the blood flow and the healing begin.
The healing from those stitches was pretty quick as those things go and there was not as much sloughing of the skin like there was around the stitches in my hand. Not that I am saying my hand was stitched incorrectly, I fully understand that would would have opened or risked popping all the stitches.