UKC

As I was waiting five hours in a&e, for a simple row of stitches on my leg, I had plenty of time to think.

One of my main thoughts, was that the ability to stitch myself up could be useful and time saving.

So, has anyone here tried it? Is it as easy as it looks? And what about those skin stapler machines? They look way more fun than going to a&e. 

I’ve accidentally sewn myself to cloth before without noticing so I’m not worried about the pain side of wound closure, but not having sterile, slow dissolving thread and having a fast healing response I’d worry about making more mess removing the thread once the wound has closed up, and about infection.   I suppose it wouldn’t do any harm to add the sterile packed medical needles and thread to the zombie day box…

If Jr needed stitches and we could get help, I think their level of freak out would make it impossible (see: the great splinter and tweezers meltdown of 2022…).  

I keep some “Celox” haemostatic granules, surgical glue and applicator and steri-strips in my kit in case of wounds that need rapid closure.  Saved my fingertip once after a freak gardening accident I reckon.  

I did not know that was a thing.  I look forwards to reading what others have to say!

Absorbable sutures tend to mostly be multifilament, such as polygalactin 910 (vicryl or other versions). These are more likely to develop secondary infection than monofilament sutures, although there are sutures with an antibacterial effect.

It is better to have monofilament sutures, though they tend to be very springy, and you tend to need to put more throws on to any one knot, to keep things secure. I have used Ethilon 3/0 on a straight cutting needle, suturing up a friend when climbing in the Alps. This was ideal in that there was no requirement for needle holders with this type of needle. Unfortunately they seem to have stopped making suture packs with that Nylon/cutting needle combination. 

Nylon has some tendency to stretch to some extent, whereas Prolene has much less likelihood of stretching. Both are permanent sutures materials, which need removing, but that's ok.

There are absorbable sutures which are monofilament, such as polydioxanone (PDS et al), but they last a very long time before degrading: So if being used as skin sutures, then they will need removing.

Leukostrips are more robust.

Skin staplers: small, light, compact, cheap...

https://gpsurgicalservices.com/product/single-use-skin-stapler/

You don't want to seal dirt in a wound. The advantage of getting someone else to clean & dress the wound is that they can probably get closer to see that all foreign matter has been removed. That can use local anaesthetic to allow some serious debridement, as necessary.

My last wound-related A&E visit was after a bike prang on sharp gravel (nice choice for a national cycle trail, huh...?). I cleaned and dressed it myself, because I was heading off for a work trip that evening (I crashed taking a sharp corner too fast due to trying to rush home...). When we got to our destination, I decided it was probably good to get it seen to properly, so my colleagues dumped me at the local A&E whilst they went for dinner... Umming and arring about stitches vs leukostrips, but they opted for the latter. In hindsight, stitches would have prevented the skin flap shrinking back to leave a thick lump that took about three years to be re-absorbed.

Well, in case it was a nurse who did the 'simple row of stitches on your leg' it took her/him 3 years to qualify, 1 or 2 years of work in A&E to get general experience and to be eligible to go on various courses, then pass those courses (including the 'wound closure' course) and be signed off as competent before s/he could do it.

In all honesty, it is 'as easy as it looks'. Have a go at it, it's really a fun thing to do ...

Stapling yourself without any local anaesthetic would probably smart a bit!

I thought dental floss was the go to for big cuts. Other options include duct tape and super glue, insulation tape also works (used them all). 

Re straight needle - there’s always what Derek Knottenbelt used to call the Zimbabwe technique - ie pass a piece of suture material part way through a standard hypodermic needle, then pass the assemblage through the skin and pull the suture material through. 
 

more tissue trauma than a swaged needle of course, but opens up a wide range of suture materials, and very good for tough material.

Re pain - I used to suture my fingers together for fun- but very carefully to the thick bit of skin near the nail bed which is mostly skin cells. Your sensory bits are deeper than that and to do proper skin sutures you need to catch deeper layers, which will be painful.

Yes, this. I remember reading an article about someone in the US (mountain biker, or something) who got pretty good at suturing mates with dental floss after accidents in the middle of nowhere.

Mostly done as a temp measure until they could be seen at a proper A&E, but feedback from medical staff was that he was doing a decent job.

MY wife had surgery in France earlier this year and the skin closures were absorbable - might be in her release notes what they used, I'll have a look later.

Took about 10 days to dissolve, monitored by my Mum (ex-most things in nursing).

Ah sorry I meant all I have is standard cotton thread in the sewing kit which I expect would end badly if I used it in an emergency!

Banging on about training and experience just reeks of the elitist "leave it to the professionals" rhetoric frequently spouted by doctors, nurses, maxillofacial/cranial surgeons - and all the other such chancers and charlatans. Technology has democratised the world. OP should've just followed via YouTube tutorial rather than pandering to the medical community like that.

Cauterising a wound

https://youtu.be/IgspbZ0oOOI?si=xN3SkefqsFT4akGk

Stitching a wound

https://youtu.be/J7S4BULc-p0?si=Hv5Ch4lDO0tW5UQw

Easy.. no need for A&E  BS. Job done!

Take a look at trepanning for some eye opening DIY surgery, been going on go thousands of years.

The new generation of of body modifiers are quite interesting too.

I'm not a medical professional and haven't done a first aid course for years. What's your feeling about whether someone like me should include some or all of this in their wilderness first aid kit? (sincere question)

Captain Paranoia suggested a better alternative to the steri strips I have up thread.  It’s your call on what goes in your kit but I’d rather be able to stop a bad bleed and do a poor job of taping/gluing a wound up, and get it fixed up later by a professional, than not be able to fix the wound.  

Only time I’ve actually had to do that is at home where gardening and other hobbies are far more dangerous than the British outdoors…

I need to renew my Outdoor First Aid ticket, but the last two courses included tourniquets and haemostatic dressings (Celox granules and dressings). They were run by a former TA medic, with Afghan experience.

My point above is that such measures, including wound closures, are temporary measures to prevent bleeding, to get you to A&E for proper treatment and sterile wound closure. A trade-off between blood loss and foreign matter infection.

When I played rugby at my local club, one of the members was the local vet. The practise also sponsored the club. Any cuts received on a Saturday, and the said player was swiftly transported the very short distance to the practise, where the stitches were administered. The look on an opponents face when they were told the were off to the vets was priceless.

Wouldn't happen nowadays I suppose.

I had to have a single stitch in my big toe many years ago. The nurse said "as it's only two pricks with the needle, that's only one more than the the anaesthetic, we won't bother" That hurt a little  

I once saw a hospital consultant and during the preliminary appointment he was unable to keep his special medical head torch from dropping down his shiny head, so he had to nip out to ask the receptionist to fix it for him. I should have paid more attention to this. When he subsequently operated on me the resulting scar wasn’t very neat at all. The guy really didn’t have great fine motor skills. As my friends kindly told me, my scar looked like something from the bacon counter. Whereas I learned embroidery at school (and made a few Airfix models) and I’m still not bad at basic sewing, so I think I could probably do a better job than this one particular surgeon. If it’s sewing myself up or waiting eight hours in A&E to see a so-called expert I’d be tempted to give it a go myself next time. What could go wrong?

My last FA course (February) included tourniquets and haemostatic dressings. Was run by an ex-paramedic.

I haven't yet got either in my first aid kit.

I do have steri strips in my kit. Have used them on myself a few times, most recently when I sliced my finger with a kitchen knife.

Somewhere in the garage, I've got some out of date suture kits from expired sterile kits I've taken away (Kenya/Nepal). Not sure anyone would let me use them on them, tbh, even if they were in date. Celox granules and tape more likely to be of use until arriving at proper medical facility.

If you don't have either, use your hands! Saw one of those helicopter medical programmes on TV recently where the casualty arrived at hospital with the doctor's hand rammed in his groin for quite some time to stop him just bleeding out. Took a while for the doctor to get feeling back in his fingers!

Tomorrow I get the staples taken out of the right side of my arse. I shall report back about the pain.

I'm looking forward to my body's skilful keloiding abilities. Going off my last and only scar, I should end up looking like my arse was ripped open by a shark.

Took ten staples out of my leg the other week, it's pretty painless as is placing them, there again I've had plenty of sutures placed without anaesthetic as well. If it's only a couple there's no point in anaesthetic anyway since that hurts just as much. My wife does the easy ones at home on me and the kids.

Your right! I'd never really considered a trans-scrotal mod, sounds like a good one for DIY. The trepanning thing is getting old anyway.

Well, my evening is going to be busy!

Excellent, thanks for the responses. 

I think I'll get myself some and hope not to need them. 

never let a doctor do a nurse's job.

if you go to the GP for a blood test or something and they say "shall I just take the sample myself?" - nah! I'll get the person who does it all the time and is well practised with the needle.

it's skill that makes it look easy.

My GP is excellent at blood samples; better than the practice nurse or paramedic.

Them’s fighting words.

Thought I reply: Celox is mostly used for arterial bleeds, surgical glue is only used on certain straight cuts. Steri-strips might be a good idea but would require bandaging as well.

Learning some basic stitches is easy enough. You can even buy practise kits on Amazon: 

https://amzn.eu/d/7aIaybX

As with many things though doing it in real life is a lot messier than in training. The difference between doing it and doing it well is where the skill is. Somebody said above they were left with a hard skin flap that took ages to sort out, it’s that sort of quality of scar that shows the skill. How do you choose which stitch to use? How many? That’s experience. 
So yes it’s easy enough to learn the basics, but  difficult to get good (outside of regular practise in a hospital, hopefully you don’t need to do it a lot at home).

I've just bought a suture practice kit off e-bay (about £15) to have a go with, it's quite good with a variety of different wounds.

In the context of Jamie's "demise of the model shops" thread - what a wonderful creative hobby you've found there.

That was me. The wound wasn't stitched. So the skin flap shrank back and thickened, and granulation filled the gap.

Had it been stitched, the flap may not have shrunk back in that way.

Funny things, wounds.

I had a small fibroma removed about a year ago. Doctor did it with a biopsy punch, leaving a nice, round, hole. Stitching the edges together left a slight lump at one end, where the skin was a bit pinched. It's slowly subsiding, but I did think at the time that nicking the circle into more of a eye shape would have left a flatter result, albeit with a couple of mm longer scar.

Having skimmed through this thread I'm a bit disturbed by the amount (number of episodes) of suturing some people seem to need...perhaps some damage avoidance rather than repair might be better. Could be a slippery slope...I started with practice kits from Amazon, but felt driven to try the real thing...

I'd want any deep wound properly assessed and cleaned out before any decision made to close it or allow it to heal from the base. Example- I crashed a motorbike about 15 years ago and the footbrake pedal got embedded in my right shin. After its extrication someone in A & E sutured that wound which was the wrong thing to do as was a dirty wound, it got infected and the sutures had to be removed a week later. Its difficult often as a victim of a wound to get a good look at the extent of an injury and to clean it properly which has to be the start of the healing process.

Yes, infection risk should not be underestimated.

Friend of mine has quite a nasty scar on his shin from playing rugby - studs on someones boot scraped through the skin. He was taken into theatre to have it properly flushed and cleaned, as quite a bit of mud and grass contamination.

I'm more surprised how little people have had.

Was on a first aid course recently and the instructor recalled his one significant injury, a sprained ankle.

He was quite amused at the small sample of injuries I told him about, I didn't dare list them all that come from years of skateboarding, bmx, MTB, climbing etc etc etc

Before you condemn me, for wasting NHS resources, I got quite good at self diagnosis and treatment, only the most serious stuff resulted in a&E visits.

I’ve had a few lumps removed. Sometimes it’s done with an elliptical shape as you suggest and sometimes circular. I think the guidelines recommend closing the wound so that it’s parallel to your natural wrinkles. The one on my hand that was done ninety degrees to this was a bit of a mess to start with.

First Aid At Work courses were always embarassing for this. I was office-based and never used it in anger (at work) - but then you're sat in a room full of people from sports centres, building sites and other more hazardous environments who do use it regularly.

No intention of suggesting you are wasting nhs resources. I was thinking more of self preservation. My thought was very much how many 'cuts' some people have.

Sorry the "you" wasn't directed at you personally.

Working in engineering and playing at boatbuilding, cuts are just part of the day.

Old adage, was how many fingers were missing gave you a good indication how many years a shipwright had been working.

Just curious, when – outside of any remote expeditions – would an amateur suturing of most wounds in a normal mountaineering setting be actually preferable to just dressing them with a bandage and getting to the A&E for a proper wound cleaning, debridement, blood checks and suturing, even if a few days later at the worst if slightly remote?

As my mates' group "designated medic" (AKA the unlucky guy who gets to lug around most of the kit), my casualty with the longest delay before proper hospital care was when my mate got a pretty deep and leaking gash from some nastily sharp limestone rockfall in the Balkan Alps, far from any roads, and those few wound dressings still worked quite well for the ~2.5 days it took us to get him to a road and the A&E pros who then did the proper job of cleaning it and sewing it up properly.

I just don't see how any amateur suturing job would have actually helped there, especially given the scarcity of any sterile saline (or even semi‑sterile water) to flush the wound before the job.

I can't help but think that you're getting closer to where we need to be on this.

What would be nice is if Minor Injuries could give you a slot to come in at .. and that you'd be seen on time assuming you arrived on time.   5hrs sounds miserable.  (I am clear on why this may not be possible in practice.  I am highlighting only how nice it might ...)

Then the problem changes into one of:  "what firstaid skills do I need to have to keep my leg in one piece for 5 hrs while I wait for my minor injuries slot to become available?".  

Re: OP

In my experience .. much more is being glued and steri stripped/suture striped these days.  My firstaid kit the hills/rivers includes suture strips on the thinking that, assuming it's a minor injury, "how do I close a walking wounded injury enough ... that we can get out of here and get to hospital to fix it properly".  (If they're not walking .. then you're calling mountain rescue anyway)  I've used them in anger (not on myself) and find them perfectly intuitive to use to close an open would temporarily.  Cheap and last a long time in the 1st aid kit.

Agree on all points, though just wanted to add the idea to check the expiry dates on them. I've had the strips get gooey once when I hadn't (storing my kit in backpack lid up in the sun might not have helped).

Can anyone suggest anywhere that does Celox (or similar) dressings that would be good for a first air kit?

TIA

I use them for work and buy them from Medisave dot co dot uk.

They do a couple of different versions of Celox as well as Isreali bandages, combat tourniques and other means of dealing with serious bleeds.

edited to add, i forgot to mention Celox has a 5yr lifespan and must be replaced before then so keep an eye on your dates.

I used to take black silk sutures with me on big trips.  Easier to see what you’re doing and it was what I was used to using.  They were sterile though!

Monocryl. Probably 3-0 on a reverse cutting needle. 

The trick is to get the skin from underneath, but not go through the surface, at it were.

i have seen a surgeon marry up the sides of a tattoo successfully so they lined up. Looked very neat. 

You definitely don't want to suture in infection... Serious debridement (removal of tissue)  and/or amputation may be required... Or a coffin.