How to Deal With Open Wounds When Help is Not on the Way

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If there is one area that I feel singularly unprepared for it is with dealing with physical trauma following a disruptive event.  Basic first aid?  Sure, I can handle that and have a decent first aid kit to back me up.  But serious wounds, broken bones, and other physical traumas? Not so much.

The thing about physical traumas, and especially open wounds, is that they can occur anytime including right in your own home.  An accident in the kitchen or the yard can begin with a bloody mess and end with an unwelcome infection.  Who wants that?

How to Deal With Open Wounds - Backdoor Survival

As far as I am concerned, the moment is now.  It is time to become educated and to start learning how to deal with more serious medical matters. To help us along, I welcome contributing author Joe Alton who is allowing me to share his expertise on how to deal with open wounds.

The Open Wound

Years ago, we held the first suture class for non-medical people in the preparedness community. Our purpose in doing this was to provide education that might be useful in a post-apocalyptic setting. We felt that teaching people medical skills may save some lives in long-term survival scenarios. To us, any unnecessary death in times of trouble is one too many.

Nowadays there are a lot of folks that put on these classes.  The main goal, however, is not simply to learn the mechanics of throwing a stitch but to develop the judgment necessary to understand when a wound should be closed and, more importantly, when it should be left open.

When the medically-responsible person evaluates a wound, the following question must be asked:  What am I trying to accomplish by stitching this wound closed?

Your goals when performing wound closure are simple.  You close wounds to:

  • Repair the defect in the body’s armor
  • Eliminate “dead space” that can lead to infection
  • Promote healing.
  • Provide a pleasing cosmetic result (less scarring).

Sounds like every wound should be closed, doesn’t it? Unfortunately, it’s more complicated than that.  Closing a wound that should be left open can do a lot more harm than good, and could possibly put your patient’s life at risk.

Take the case of a young woman injured in a “zipline” accident.  She was taken to the local emergency room, where 22 staples were needed to close a large laceration.  Unfortunately, the wound had dangerous bacteria in it, causing a serious infection which spread throughout her body.  She eventually required multiple amputations.

We learn an important lesson from this tragic case: Namely, that the decision to close a wound is not automatic but involves serious considerations.

Infected Cut

The most important of these is whether you are dealing with a clean or a dirty wound.

Most wounds you will encounter in a wilderness or collapse setting will be dirty.  If you try to close a dirty wound, you sequester bacteria and dirt into your body.  Within a short period of time, the infected wound will become red, swollen, and hot.  An abscess may form, and pus will accumulate inside.

Here’s an article I wrote about infected wounds: Infected Wounds

The infection may spread to the bloodstream and, when it does, you have caused a life-threatening situation.  Leaving the wound open will allow you to clean the inside frequently and observe the healing process.  It also allows inflammatory fluid to drain out of the body.  Wounds that are left open heal by a process called “granulation”; that is, from the inside out. The scar isn’t as pretty, but it’s the safest option in most cases.

Other considerations when deciding whether or not to close a wound are whether it is a simple laceration (straight thin cut on the skin) or whether it is an avulsion (areas of skin torn out, hanging flaps).

If the edges of the skin are so far apart that they cannot be stitched together without undue pressure, the wound should be left open.  If the wound has been open for more than, say, 6-8 hours, it should be left open; even the air has bacteria, and the injury may already be colonized.

IF you’re certain the wound is clean, you should close it if it is long, deep or gapes open loosely. Also, cuts over moving parts, such as the knee joint, will be more likely to require stitches.

Remember that you should close deep wounds in layers, to prevent any un-approximated “dead space” from occurring.  Dead spaces are pockets of bacteria-laden air or inflammatory fluid in a closed wound that may lead to a major infection.  An exception to this is a puncture wound from an animal bite.  These are loaded with germs and should never be sutured.

If you are unsure, you can choose to wait 72 hours before closing a wound to make sure that no signs of infection develop.  This is referred to as “delayed closure”.  Some wounds can be partially closed, allowing a small open space to allow the drainage of inflammatory fluid.  Drains, consisting of thin lengths of latex, nitrile, or even gauze, should be placed into the wound for this purpose.  Of course, you should place a dressing over the exposed area as it can get messy.

Improvised Butterfly Closure with Duct Tape

If you must close a wound, use the least invasive method.

If you can approximate the cut edges of skin with butterfly closures, it is better than puncturing the skin again and again with sutures or staples. Use an adhesive such as tincture of benzoin to hold the tapes in place. Even Super-Glue may be a better option in certain cases, and is used routinely in underdeveloped countries like Cuba with good effectiveness.

Irrigating the Wound

The safest method, though, is to leave that questionable wound open.

Using a 60-100cc irrigation syringe, flush the area aggressively with a dilute solution of Betadine (Povidone-Iodine) or sterilized saline solution. If you don’t have commercial sterile solutions, studies show that clean drinking water can keep a wound clean in an austere environment.

Place a sterile moist (not soaking wet) dressing in the wound and then cover with a dry sterile gauze dressing. Replace the dressing at least daily, more often if possible.

If you have antibiotics, this may be a good time to use them. Check out the link in this article about infected wounds to see which are most useful.

About hydrogen peroxide, undiluted Betadine, or Alcohol as a cleaning agent for open wounds:  If it’s all you have, it’s ok for the first cleaning before you place the dressing.  These substances, however, tend to dry out newly forming cells and may actual hinder healing.  As such, stick with milder solutions or clean drinking water for long-term wound care.

Learning how to suture is a useful skill. Knowing when to suture, however, is much more important.

Joe Alton, M.D., aka Dr. Bones “Doom and Bloom” Survival Medicine

Takeaway: Many Wounds Should Be Left Open

Before now, I was under the false impression the all serious wounds should be closed up or sutured to prevent infection. Little did I know that closing a wound, especially while out in the field, should be carefully evaluated if there is any hint of dirt or bacteria. Sometimes, closing a wound will foster an infection and make it worse.  Who knew?

Here is the takeaway for determining whether a wound should be left open:

1.  If the wound has been open for longer that 6 to 8 hours, leave it open.  During that period, bacteria will have had time to work its way through the body, potentially causing a massive infection.

2.  If the flaps of the wound cannot be closed without using a lot of pressure, leave it alone.

3.  To repeat: dirt and bacteria will cause an infection if allowed to fester in a closed up wound.  If there is any suspicion of such, leave the wound open!

The Final Word

After digesting Joe’s advise on open wounds,  I pulled out my copy of his book, The Survival Medicine Handbook (written by Joe and his wife, Amy) to see what else it had to say on the subject.

Note: this is a big fat book of over 500 pages.  I keep in next to my desk and use it as a reference, but I have not read it cover to cover.

In chapter six, I found lot of information on open wounds including photos and extensive details on the use of commercial hemostatic agents (such as Quickclot and Celox) and suture instructions for those hopefully rare times when suturing will be needed.

The book also mentions something I already knew and that is that it is a good idea to apply some triple antibiotic ointment to a healing wound or, as I prefer, raw honey, lavender oil or to Melaleuca (tea tree) essential oil.  Lavender, especially, is something I always carry with me in my portable survival kit (see 8 Essential Items: The Perfect Portable Survival Kit).

At the end of the day, I am more than a little bit discouraged by how ignorant I am about wound control and other physical traumas.  That said, as with everything preparedness related, there is always something new to learn and of course, it is never too late to start.

Enjoy your next adventure through common sense and thoughtful preparation!
Gaye

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Spotlight Item:  THE SURVIVAL MEDICINE HANDBOOK is a guide for those who want to be medically prepared for any disaster where help is NOT on the way. 

It is written from the non-medical professional and assumes that no hospital or doctor is available in the aftermath of a catastrophic event.  It covers skills such as performing a physical exam, transporting the injured patient, and even how to suture a wound. This medical reference belongs in every survival library.

Bargain Bin: Survival is all about learning to fend for yourself. Here are some of the emergency medical reference books and supplies that belong in every household first aid kit.

Quikclot Sport Brand Advanced Clotting Sponge: A must for any first aid or emergency kit, Quikclot Sport stops moderate to severe bleeding until further medical help is available.

CELOX First Aid Temporary Traumatic Wound Treatment, 10-Pack: These small packets of granules will stop bleeding within 30 seconds. To use, pour directly on a wound and apply pressure; it won’t sting or burn. Also safe for pets.  I like that the small packets are portable.

ProAdvantage Sterile Butterfly Closure Bandages:  I checked my first aid kit and only had a few of these.  This box of 100 is about $6.

Irrigation Syringe, pack of 6:  I had a few of these left over from visits to the dentist but it never occurred to put them in my first aid kit.  I am learning so much these days!

Tincture of Benzoin: This is another one of those items I had never heard of.  Its purpose is to hold a bandage or dressing in place.

Betadine Antiseptic or Dynarex Povidone Iodine Prep Solution: Either can be used diluted as a disinfecting solution for wounds.  Also good for day to day cuts and scrapes.

Israeli Battle Dressing, 6-inch Compression Bandage: This is another inexpensive, yet critical item. Combat medics, trauma doctors, and emergency responders all recommend this Israeli Battle Dressing (IBD) for the treatment of gunshot wounds, puncture wounds, deep cuts, and other traumatic hemorrhagic injuries.

New-Skin Liquid Bandage, First Aid Liquid Antiseptic:  I have been using New Skin for years.  It is an antiseptic, invisible, flexible, and waterproof.  It works.

Super Glue  – The Original: This is the original Super Glue brand.  This works a lot like the liquid bandage above in that you apply it to the wound and when it’s dry, it will hold the cut together. Also check out Krazy Glue or Gorilla Brand Super Glue.

Pac-Kit 5-910 Self-Adhering Cohesive Wrap: I first learned about self-adhesive bandages when my dog came home from the vet such a bandage wrapped around his leg.  A light went off telling me I needed to add some to my first-aid kit.  And so I did.

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Essential Oils for the First Aid Kit

Consider adding an assortment of health and wellness related essential oils to your first aid kit.  At a minimum, include melaleuca (tea tree), lavender, oregano, peppermint, rosemary, and clove oils.  At a cost of less than $45, these six essential oils will serve you well in a wide variety of first aid and emergency situations.

You can read about these and other healing essential oils in 20 All Purpose Remedies Using Essential Oils or other articles on this archive page: Interested in Learning About Essential Oils.

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Comments

How to Deal With Open Wounds When Help is Not on the Way — 12 Comments

  1. This is an area I don’t feel as comfortable in. Thanks for sharing and causing me to think ahead, better prepare and look ahead to be better prepared. Keep Looking UP

  2. Gaye, I just took a suturing class with my husband Mark. I finally have two suturing kits and know I can suture shallow and deep wounds. BTW the doctor was so patient with everyone in the class, he would help each one of us learn to tie the “knots” correctly.

  3. Gaye, fantastic article. I never get tired of learn more about field medicine. I had no idea the decision over whether to suture is so critical. I have wanted to suture a wound ever since Dr. Jack on LOST had Kate douse his wound with vodka and stitch it up with a sewing kit. And then there was the time on Grey’s Anatomy when Christina hacked apart a raw chicken and told Dr. Burke to suture it back together to prove he had overcome his hand injury. I’ve been hooked ever since because this is something real people can learn to do.

  4. Since I tend to get a bit cocky with a knife while doing prep work for cooking dinners at home, I have sliced the fatty tip of my left thumb off three times now. I know it is my own carelessness so don’t go there please. It usually removes about a 1/8 inch thick chunk and bleeds like crazy! Once cleaned with soap and water a couple drops of super glue will seal up the bleeding. I use triple antibiotic ointment on it and change the dressing every day.
    The first time I did this I could not stop the bleeding and read about super glue on the internet. It works well and is fast, but in my case I should just slow down and be more careful in the future. A tube or bottle of super glue takes up no room at all in a first aid kit and might be just what the “doctor” ordered.

  5. This was a very informative article. I too thought all wounds should be closed up but this makes me rethink that position. I think I need to educate myself better in this area. Thanks Gaye.

  6. This is a weak area for me as well. I appreciate the information you shared and I’m adding The Survival Medicine Handbook to my wish list. Great article.

  7. Very good article. As a nurse with 30 years experience in dealing with complex wounds this is well written. So my question is how could a person make jars of sterile saline? what would the solution of salt (what type?) to water be and could it be made in a pressure canner for use later? I know it would be a very handy thing to have.

    • You question had me curious so I did some rudimentary research and it appears that properly prepared saline, whether normal or sterile, has a shelf life of only 2 or 3 days. Sterile saline requires distilled water.

      There are lots of articles out there but I wanted a credible source so I looked for info at hospital websites. Here is one from Childrens in Seattle: https://www.seattlechildrens.org/pdf/PE610.pdf

      I could not find a definitive answer to the shelf-life of pressure canned saline water.

      • Thanks for following up on the sterile saline question. I think its good information to know. Sterile saline would be very handy to have around. Or at least having the information on how to make it.

  8. I’m wondering if colloidal silver would be a good alternative if you don’t have saline solution to flush a wound.

  9. i would never super glue, gorilla glue a wound, buy a suture kit and antibiotics fish mox, or triple antibiotics, or just plain neosporin, keep peroxide, and alcohol and iodine on hand but do not super glue wow

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