I’ve had plenty of gaping wounds and have only gotten stitches in about half of them.
I wouldn’t bother with the stitches. Odds are you’d only wind up with an infection oozing puss from between the stitches and a lot of scar tissue. Hopefully you’d have some surgical soap or peroxide at least. (Boil some water to make sure it’s clean) Clean it out good, butterfly it with some XXXXX’s and wrap it with gauze. If it’s a bleeder take the gauze and pack it. Clean it out a couple of times a days…repack it and cover the open area with a more gauze. (clean cotton cloth will do if need be)
If the wound is that deep, you’d probably need some internal stitches or dissolving sutures. A deep wound needs to heal on the inside first. Without the sutures the surface may heal, yet inside you wouldn’t be. What comes next is the reopening of the wound so it can be cleaned out again and then stitched properly…gangrene, septic, etc… = not fun
BTW You asked about numbing the wound. I keep a bottle or tube of oragel or anbesol with me, pretty much all the time. My first aid kit (which is usually with me), has all kinds of stuff in it BUT extra strength Oragel or liquid Anbesol works great.
I figure if it is safe enough to put on an exposed nerve in your mouth it’d be safe anywhere. I’ve burned my eyes welding before and have had metal shavings in my eye. Couldn’t get to the eye doctor.
A little dab’ll do ya. It’s gonna burn for a couple of seconds but after that your eye just numbs right out. With a burn you’ll be able to sleep and in the morning they’ll be healed.
With the object in your eye…it’ll at least keep you from rubbing it (causing more damage) until you get to a doctor. With something in your eye. a little oragel then close your eye and tape it shut…cover with a patch and get to a doctor asap. I have removed a lot of particles with a Q-Tip
BUT that’s ME…(disclaimer follows)
Just had my refresher Wilderness First Aid course this weekend. There’s really no reason to stitch something up in the backcountry unless it is the only way to perform an evacuation, and I can’t really think of a situation where stitches are needed for evac.
Clean the wound (lots of drinking quality water), bandage, and if it was going to be a long trip out I’d keep the wound open rather than taped shut. Anaerobic bugs tend to be nastier and and open-packed wound is easier to monitor and re-clean.
The main reason for stitches is to promote scarless healing. Anything you jury-rig in the backcountry isn’t going to be able to do that. Once the bleeding is stopped (and any cut can be controlled) pack the wound and evac as best you can.
Oh goodness, there a a million kinds of stitches, depending on where the wound is and what your aims are- cosmetic, prevent blood loss, drain infection etc.
There are continuous, interrupted, vertical mattress, horizontal mattress, sub-cuticular, all kinds of things.
If in doubt, I wouldn’t guess.
Tape and pressure would probably be the best thing.
Oh, and if there is something large embedded in the wound (big shard of glass, knife, piece of metal etc) it’s probably not a good idea to remove it unless you’re set up for a transfusion there and then. Pack around the object and apply pressure to stop the bleeding, in such a way that the object is not pushed further into the wound.
If a wound is clean and not bleeding profusely (a little ooze is ok, a severed artery isn’t) it can be safely left for a few hours before suturing. It’s not like any wound HAS to be closed then and there.
A guy in our emergency room had to wait several hours for a plastics consult (plastics on-call doc was in surgery), with a large flap laceration to his arm. He got local anaesthesia and the wound was cleaned and dressed, but not sutured, there was no harm done.
I can just imagine Ron Popeil reading this thread and inventing the “Stitch O Matic” for hunters and fishermen. I go for the duct tape method. If it’s on your arm, you’d have a devil of a time doing it one handed. Maybe on the leg you might do it but I think you’re better off taping it quickly and taking the time that you would spend on stitching and use it to get thee to an ER.
I used plenty of Ambesol to numb the area, a small medical clamp to hold the skin together, and nylon thread to stitch. Two separate loops, tied with square knots. Twenty-some odd years later, I still have a pretty good scar on the back of my hand.
If I had been thinking clearly, I would have used grey tape.
Hell, if I had been thinking clearly, I would have realized I wouldn’t get in trouble for injuring myself doing my chores, and gone to a neighbor’s for help.
Depending on the placement of the object it is often recommended that you remove the object if you are in a wilderness setting. Unless the object is in the head or torso it probably makes the most sense to remove the object to make self-evac or litter carry easier. Wilderness protocols are different from frontcountry, removal will make other actions much easier. I would still hesitate if I were close to the femoral artery, but otherwise it’s going to get removed.
One other type would be an impaled metal object (ice axe) in a cold environment. If you don’t remove it fairly quickly the victim will go hyperthermic fairly quickly and it should be removed.
If you think help will arrive soon and make for an easy evac, then leave the object in place and pack. Otherwise it should probably be removed, at least according to the current protocol.