Deep Cuts (First Aid)

[Nuts]

I like simple and creative solutions... so I thought I'd save this one somewhere:

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(From paddling.net)

[slparker]

Too much skin tension. That's going to lead to a puckered scar or, at worst, the wound will come apart when the laces are cut.

[GPSGuided]

It's 'first aid', whatever that means. So I don't expect considerations for wound healing to be relevant. If it's deep, it needs to be sutured upon evacuation anyway. So the question is, why not just use standard wrapping bandage. Otherwise this reminds me of that old 'zipper' laparotomy closure solution, catering for convenient re-access needs.


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[slparker]

It's 'first aid', whatever that means. So I don't expect considerations for wound healing to be relevant. If it's deep, it needs to be sutured upon evacuation anyway. So the question is, why not just use standard wrapping bandage. Otherwise this reminds me of that old 'zipper' laparotomy closure solution, catering for convenient re-access needs.


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it is a common misapprehension that first aid treatments need to be conducted without reference to whether the wound benefits.

if the wound is going to be closed (and this photo looks like an attempt at a primary closure) than it needs to be done right. If the wound is going to be sutured prior to evacuation it needs to be done right. I still don't know why you would attempt primary closure in the field in a wound of this size unless evac was delayed.

perhaps evac was delayed - in which case this picture does not display an examplar of wound closure.

If WW1 taught us anything it is that delayed closure for dirty and ragged wounds is the way to go.

[Nuts]

I can't imagine needing suturing or suturing alternates in the modern timespan for evac either, and it would be difficult to prevent infection if the idea was to contine on ( with a remote walk, and depending on the wound and considering what else is in the First Aid kit ). Either way I know what method id prefer without local anaesthetic and this looks sound for simple external stitching. Suturing has been discussed on here though I had thought it down the list for bushwalking FA, others don't.


Can't see it well enough here, they are string ends not skin folds? ( I'd expect it's a dummy wound?)

[Moondog55]

I thought those were simply pen marks to simulate a long deep wound.
If I was working on my own leg or arm and I needed to close a slash up to stop bleeding I'd be willing to try it if a pad and pressure wasn't working and I didn't want to use a tourniquet
Maybe a better way to close up an open abdomen and stop your guts falling out in heap than bandaids/steristrips
Not that I carry duct or bagger tape usually

[taipan821]

if the wound is going to be closed (and this photo looks like an attempt at a primary closure) than it needs to be done right. If the wound is going to be sutured prior to evacuation it needs to be done right. I still don't know why you would attempt primary closure in the field in a wound of this size unless evac was delayed.

perhaps evac was delayed - in which case this picture does not display an examplar of wound closure.

as a way to promote clotting cascade and healing its a good attempt. I hope they took the time and effort to clean the wound with cool boiled water before hand, closing wounds in the field is haphazard to say the best, and there are specific methods to do them in field (check out medical texts) but wound closure is beyond first aid and, although I am trained to do single-layer suturing (skin only, no muscle) I wouldn't be game to even think about on the side of a track

[GPSGuided]

A closure like that would be useless unless the patient is immobile. It wouldn't hold up with a bit of walking. It may have a role in primary closure when managed in a proper clinical setting. Out in the field, it's meaningless for a _deep_ wound (thread's title) for it can't possibly maintain wound stability and let alone any 'healing'. It'll just pressure the skin and promote a nasty collection underneath, waiting to get infected. May have a role in superficial lacerations, but then why not just use Steristrips? Far simpler and readily available.


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[Nuts]

'Deep' is relative and some body parts can be immobilised while walking? the thought process interests me, short on promotion in a 2 day course. I always carry tape and floss/ needles for repair, I'd use it on my guts too moondog lol.(And get out ASAP)

[GPSGuided]

Deep to me is one that goes beyond the skin layer, into subcutaneous fat and then muscles as well as others.


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[Nuts]

Yes, and the accepted options are limited with evac and imagined situations in mind. It's a wonder a system (between strips
and suturing) hasn't been further developed along these lines for gp's, adjustable and strong. I had some surface sutures last year and the outcome was as predictably ordinary as it's ever been.

[GPSGuided]

Good old hand suture is cheap and works. The negatives don't kill.

[johnw]

I know this is slightly OT but what is the view of using super glue for cuts? Probably not for very deep ones though. I mean just ordinary super glue that you can buy anywhere, not the very expensive surgical type. I've read a lot of mixed opinions.

[Hermione]

Superglue works fine, it's very similar to surgical skin glue, but there's a few things to consider. The type and location of the wound, minimal tissue loss is best so you can still oppose the skin edges (say you cut yourself with a knife), a fairly superficial wound in a location on the body that isn't particularly mobile is probably most suitable (even superglue isn't that strong). If the wound is dirty there's not much point gluing it as you'll just be sealing in the microorganisms, but if it's reasonably clean superglue can provide a fairly water proof barrier. Before you apply glue you also need to consider if its like to need suturing at a later stage, as the glue can be hard to clean off which might mean more tissue loss. I'd still consider using it for certain things in the bush, on the face it can be useful because it can be hard to get an adhesive dressing to stay on (keep it away from your eyes though).

[johnw]

Thanks Hermione, that sounds like good advice. Yes, superficial and clean is what I was thinking. Even something like a paper cut I guess.

[GPSGuided]

I have quite a bit of commercial superglue experiences on live tissues from a while back. The hardest part is that they are more fluid and is harder to control during application than the clinical version. The newer gel version may be better but I don't have any experiences with this formulation. Otherwise the use of a toothpick is desirable to control the application, in small amounts. Excessive amount would interfere with the healing. For people without experience, it'd be easy to fill the wound cavity with the glue and that's a bad thing. Much easier to use Steristrips and to use it well for the less experienced.

[Nuts]

Good discussion. Better than accepting (or rejecting) ideas without consideration.
Why would store available superglue be encouraged for specific carry in a first aid kit? There are some dirt cheap options there that could contain anything.. Is the medical grade available (I'd not bother adding it but..)

[rcaffin]

All very academic. Reality can be different and more difficult.
This was a ski accident involving the very sharp edge on new XC skis and a too-steep hill.
The photos show slashed ski trousers with a bandaged wound inside (coffee time)

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the wound itself a bit later being cleaned up (still in the mountains)

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and the wound a day later after three layers of fancy stitching around midnight on a quiet night in Cooma Base Hospital.

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The wound was closed with nothing more than BandAids and Micropore tape, with a good layer of folded TP over the top and a bit more tape to hold it in place. The victim then skied and walked out to the car, many km. Yeah - THREE layers of stitching - the wound was a bit deep.

The point of all this is that you can do tremendous First Aid with very simple stuff. Don't worry about trying to do surgery in the bush - just patch things together simply and get the victim out to PROFESSIONAL assistance. In this case helivac was not needed.

Full credit must be given to the emergency surgeon in the the Cooma Base Hospital. Midnight and only one patient, so she 'went to town' with the stitching. The nurse commented that she had never seen complex stitching like that before, although she had read about it. There is little trace of the scar a few years later.

Cheers
Roger

[vanNek]

Irriagte, dry, tape/butterfly clips, evac, plain and simple!


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[GPSGuided]

Nice! A sharp ski edge is like a sharp scalpel blade, leaving a clean cut. Best for healing and minimal scarring. Yep, just wrap it up and KISS whilst out there. Let the professionals sort it out when evacuated.

[Nuts]

I guess there are few places left on this orb where money can't buy evacuation and/ or treatment for those lucky enough to be able to ((play and) pay. The final outcome in fact relies on a lot of technology and knowledge .. along with that fortunate privilege.

I'm still curious (not convinced) abt carrying generic superglue.

[Moondog55]

Well I always carry suoerglue in my repair kit in winter but I'd never use it to close a wound simply because I've never been taught how to do it properly.
Despite looking fairly gruesome the cut in Rodgers post really is superficial [ or looks to be anyway] no major blood vessels opened, no bone exposed etc

Which makes me ask "What is considered a deep cut these days?"
I've seen some very bad cuts in my time in kitchens, cut myself badly a couple of times and apart from treating the immediate wound to stop bleeding and treating the victim for shock they all went to the local doctors for treatment or we called the ambulance. In all of my walking climbing and skiing I've been lucky and never had to do any first-aid except for treating hypothermia and blisters

[GPSGuided]

I'm still curious (not convinced) abt carrying generic superglue.

As said, proper and clinically efficacious use of 'superglue' for wound management require experience, training and judgement. For the untrained, much better to use Steristrip or simple bandaging. Superglue was a hit for the paediatric group as an alternative to needles and sutures. But again, it has limits and requires proper wound care before application (leading to wound closure). For wounds 'out there' and without a quick exit, you are much better advised to manage it traditionally as it would be a contaminated/dirty wound, one that's better given an opportunity to drain than sealed up by superglue, leading to suppuration, abscess underneath and potential septicaemia. So forget it.

'Deep cut' by clinical definition is one that requires a second layer of suturing, one that typically involves the fat and muscle layer under the skin or further. Anything less would be superficial and can be closed by simple single layer skin suture/Steristrip/superglue etc.

[Moondog55]

So is there a clinical definition where the cuts are so deep the the bone is exposed? I've had a couple of those already having almost severed my thumb once and sliced the top of my left index finger right off , in the days before boning gloves were mandatory

[lee737]

So is there a clinical definition where the cuts are so deep the the bone is exposed?

Depends on what bone you are looking at! Tibia, skull, not so deep..... femur - *&%$#! deep!

Seriously.... if the bone is exposed it just implies higher risk of infection through depth, and more chance of injury to structures between the skin and the bone, which are the most important bits. If the bone is damaged, we call it a compound fracture.

[lee737]

It's 'first aid', whatever that means. So I don't expect considerations for wound healing to be relevant. If it's deep, it needs to be sutured upon evacuation anyway. So the question is, why not just use standard wrapping bandage. Otherwise this reminds me of that old 'zipper' laparotomy closure solution, catering for convenient re-access needs.

Good advice.... For large wounds, the #1 priority is controlling blood loss, #2 is preventing (further) contamination. Clean it out, cover it up, make sure it isn't bleeding, and evacuate.

[TwoDuck]

Local anaesthesia after having a coffee? If so, well done!

[Moondog55]

So is there a clinical definition where the cuts are so deep the the bone is exposed?

Depends on what bone you are looking at! Tibia, skull, not so deep..... femur - *&%$#! deep!

Seriously.... if the bone is exposed it just implies higher risk of infection through depth, and more chance of injury to structures between the skin and the bone, which are the most important bits. If the bone is damaged, we call it a compound fracture.

I'd hardly call a wound where the bone isn't broken a fracture
I've cut myself along the bones of my hands a couple of times, damaging the bone sheath and exposing the bone to the open air but neither time did I actually break the bone
Yes It hurts, hurts greatly but they heal eventually and with only minor loss of sensation and strength, thank the researchers and scientists for the antibiotics and I'm glad they were not resistant strains

[lee737]

If the bone is damaged and there is a communicating wound to the surface, it is a compound fracture, might be a minor one though....

[Moondog55]

If the bone is damaged and there is a communicating wound to the surface, it is a compound fracture, might be a minor one though....

Not by the definition in my online medical dictionary

open fracture one in which a wound through the adjacent or overlying soft tissue communicates with the outside of the body; this must be considered a surgical emergency. The compounding may come from within (by a bone protruding through the skin) or from without (e.g., by a bullet wound communicating with the bone). See illustration. Called also compound fracture.