How to Survive the End of the World as We Know It - James Wesley Rawles [63]
You must be careful to hold the wound margins together tightly to apply Dermabond, as any solution that makes its way into the wound may itself prevent healing, and with Dermabond the trick is to keep your fingers from being glued to the wound while waiting the few seconds for it to dry. I do not advise using Dermabond for a wound that has a tendency to continue bleeding the minute pressure is removed, nor in a wound that is deep or under stress. It works well on some facial lacerations, but I trust Steri-Strips to do the job, and they could easily be part of a medical kit.
Wound margins should be closely approximated prior to the application of any binding material, including Steri-Strips or tape. If you are reduced to using duct tape, first tear several inches off the roll so that what you use on the wound has not been in contact with a dirty surface. Then tear or cut three or four inches off and cut that into one-eighth-inch to one-quarter-inch strips, taking care to keep your hands from touching the part of the tape that will be over the wound. Pressing the wound edges together with one hand, or having a helper hold them together by pushing from each side, apply the strips of tape, starting on one side and pulling firmly to apply some tension before allowing the tape to adhere to the other side of the wound. Space these strips one eighth to one quarter of an inch apart to allow the wound to breathe, and then cover with sterile gauze secured by tape or an ACE wrap (or cotton bandage) to keep it from being recontaminated.
I would not worry about small defects or ragged edges. Individuals who are sensitive to adhesives may develop blisters where the Steri-Strip or tape is located, but this is usually just a local reaction and does not cause systemic allergic symptoms. In someone who is unable to tolerate adhesives, sutures or staples should be used for larger wounds requiring closure.
Suturing is a technique that is learned and should be practiced prior to use, which is not to say that any accomplished seamstress couldn’t master it. Many wounds will greatly benefit from needle and thread. However, to reinforce the importance of asepsis in wound care, I should again point out that a wound should not be sutured by an untrained individual in a nonsterile environment if there is an alternative. If there is not, then any asepsis that can be accomplished by boiling or autoclaving (pressure-cooking) would be of benefit, and extreme care should be taken not to further contaminate the wound while attempting to close it in the best possible way. What is obvious to medically trained personnel—microbial contamination and how to avoid it—is the major impediment for the layperson. Sterile drapes and sterile gloves are a bonus. But most medical staff would agree that primary closure is better than a large wound left open in most cases. In our current political-legal climate one could be prosecuted for “practicing medicine” without a license if it appeared that extraordinary measures were undertaken by the layman who had other options, so be sure that you are doing so out of necessity. In a TEOTWAWKI setting, you will probably wish that you had at least studied the technique (and had obtained the proper equipment and practiced on some animal skin).
Some wounds are by definition contaminated or infected and are better left unclosed. These include puncture wounds, stab wounds (deeper than they are wide) that are not bleeding profusely, and animal or human bites. These should be cleaned and scrubbed as above, taking even more care to flush them out if possible, with bleeding controlled with pressure only. If that’s not possible, then one or two sutures or Steri-Strips can be strategically placed.