Backcountry wound repair.....

In past threads, how to care for wounds in the back country was often discussed, sometimes in controversy. I've carried sutures in my first aid kit for years, and have used 'superglue' (at my own risk, as well as yours, should you choose to go that way) on small cuts with very good success. Lately, a pharmacist friend of mine provided me with a couple viles of "Dermabond" which is the real deal with regard to surgical wound adhesives. This is what I'll be carrying in my first aid kit, along with superglue (cheap and effective for little cuts) and sutures. Knowing how to triage and prepare a wound is crucial to success and a wilderness first aid course is recommended, however, I thought folks would enjoy reading about using "Dermabond".

http://www.aafp.org/afp/20000301/1383.html

Opinions?

Because I wear sandals so much in the summer [although not for hiking], I occasionally get cracks in my heels which are very painful. I find super glue great for these, as well as for the tiny cracks I get in my fingers in wintertime. After some initial stinging, it stops the pain and aids in healing by keeping the wound approximated. A definite 'must' in my first-aid kit.

A while ago, I did a year as a sprinkler technician. I was fortunate enough to cut my hands and fingers at least once a week with semi-deep cuts. Because I still had to do my job, I had to cover the cuts in such a way to prevent infection. Most of my job consisted of digging, cutting pvc, and sticking my hand in dirty water. So, after I was cut, I would usually put some neosporin, and then cover with pvc glue. I am sure that a lot of people are going to tell me that it was a bad idea. I am not a doctor, and all I can say is that it did what I wanted. It killed any germs, sealed the cut so it could heal, and prevented furthur contamination. The next day I would usually put more neosporin on it, cover it with white sports tape, and then coat the tape in pvc glue.

Needless to say, in my non-doctor opinion, I think using a proper adhesive to seal a cut is better than band-aids.

So, should I expect any after-effects from the pvc glue down the road? <img src="/forums/images/graemlins/grin.gif" alt="" />

"So, should I expect any after-effects from the pvc glue down the road? "

That all depends upon whether you used the purple primer prior to the glue....
HAHAHAHAHAHAHA! <img src="/forums/images/graemlins/grin.gif" alt="" /> <img src="/forums/images/graemlins/grin.gif" alt="" /> <img src="/forums/images/graemlins/grin.gif" alt="" />

Seriously, if you read that Dermabond article, it talks about smearing 3 coats around the wound to do exactly as you did. I've gotten PVC cement...and primer...all over myself, as you know happens....with no effects at all. In 20 or so years, if I get tumors growing out of my head....who the heck knows?

Speaking from experience...the purple primer kills all the germs, stings like crazy, and prevents the cut from healing. Also, no matter where on your hand the cut is, as soon as you open the primer, it will jump out and rush straight to the cut to make sure you feel it's rath <img src="/forums/images/graemlins/shocked.gif" alt="" />. Gotta love the purple stuff!

Just don't let us hear any stories about how you had a great time camping, all because you used some glue to close a cut, and spent the rest of the time sniffing your finger! <img src="/forums/images/graemlins/smile.gif" alt="" />

<img src="/forums/images/graemlins/grin.gif" alt="" /> <img src="/forums/images/graemlins/grin.gif" alt="" /> <img src="/forums/images/graemlins/grin.gif" alt="" />

Neither sutures nor dermabond are recommended in the backcountry. Wounds should be irrigated thoroughly, then closed with steri-strips or butterfly bandages and covered with a dressing (Opsite is a good choice).

Sutures are definitely a no-no - stitching up a wound in the woods is an invitation to infection. Dermabond might be OK for minor cuts.

"Neither sutures nor dermabond are recommended in the backcountry."

Personal choice, wound type, and skill level have a lot to do with it. Recommendations are generalized statements.
Where I hike mostly, it's so remote, helicopter rides are 1 1/2 hours each way WHEN they hear about you. Help can be days away or never. Especially if I'm solo, I'm going to address the situation the best I can.
Sometimes doing what's NOT recommended is the only way you'll get home.


Not talking about major surgery here. <img src="/forums/images/graemlins/grin.gif" alt="" />

When I was in my younger days, I worked as a glazier. One of the occupational hazards of this trade was/is getting cut a lot; mostly on your hands and wrists. Some of the cuts would be deep, others would be shallow, but they would all be relatively clean. Early on, I found that healing went a lot faster if I was to just wash a cut and then let it be. Especially with the deeper cuts, a bandage would almost always lead to some level of infection; leaving a cut open to the air would be painful on occasion<img src="/forums/images/graemlins/shocked.gif" alt="" /> but seldom led to any infection at all. The only problems with not closing the deeper cuts is that the resulting scars are worse than if the cuts are surgically closed; parts of my hands look like a road map: And, customers would complain if you got blood on their draperies. <img src="/forums/images/graemlins/mad.gif" alt="" />

I irrigate the wound thoroughly debried it and then loosely cover it with non stick gauze if I think the rest of the day will expose it to infectious materials. I check it every few hours to make sure it's not getting redder= infection. If it is then i hit it with an anibiotic cream. If the wound is deeper than half an inch i dress it in wrapped gauze and change that as needed until I hit the trailhead. lots of scars, no death here yet <img src="/forums/images/graemlins/smirk.gif" alt="" />

Bmisf is right, sutures are usually a bad idea. I have used PVC cement at work and it does the trick. I worked as an appliance repairman and regularly cut my hand on dishwashers, stoves and washing machines, sometimes full of nasty water. I would wash with soap, then use honey for a few days. Yes, honey is much better than neosporin. Neosporin will dry out a large scab and cause it to pull and bleed around the edges, honey keeps it soft and amazingly averts infection. For me, IMHO it has amazing healing properties and antimicrobial. No one makes any money from selling it. Neosporin tastes funny on your muffins too.

Ecrow

Now you tell me. <img src="/forums/images/graemlins/tongue.gif" alt="" /> <img src="/forums/images/graemlins/blush.gif" alt="" /> <img src="/forums/images/graemlins/shocked.gif" alt="" /> <img src="/forums/images/graemlins/smirk.gif" alt="" /> <img src="/forums/images/graemlins/grin.gif" alt="" />

You sure opened a can of worms with that remark! <img src="/forums/images/graemlins/grin.gif" alt="" /> No further comment here. Brum

Dryer. YES! Thanks for this heads up on DermaBond! I've been carrying around a suture kit for a while now, only had to it use three times, on other people, but suturing is not my thing. I'll continue to carry the suturing kit, but will add the DermaBond to my Med kit for minor cuts. I just looked at the link you posted here, and also went to the DermaBond site. Do you have any suggestions on where to order two DermaBond pens with shipping included? Is a prescription needed to purchase it in the states? Thanks again, Brum

That's the problem with Dermabond...it requires a prescription. I got mine from a pharmacist friend and again from a pediatrician buddy. It's expensive...each vial/applicator, had I paid for it, was around $25. Samples are out there, ask your doc....they'll likely give you some if they know why you want it.
I think there's an over the counter version too, now.
Yup, my sutures will stay in my pack too but I've glued myself plenty of times.

I don't know if this will help but, Band aid brand makes a liquid band aid product. I'm not sure of what size cuts it might seal but I've used it on small cuts aroundthe house and it kinda stings when you put it on. Maybe a dose of that and them some super glue. Hope this helps.

Yes, it is controversial anywhere I've read about it. I personally carry a syringe to irrigate the wound with povidone iodine and then pack the wound with nitrofurazone. This is what I would use on myself because it is what I carry to use on my dogs when they sometimes decide to tear into each other in the middle of nowhere. I get nitrofurazone paste from the feed store. I have yet to see an infection set in a deep puncture on a dog after discovering and using that stuff. I suspect it would work well on me too, even though it is not human grade. It sure does store well, being a small simple molecule with broad spectrum antibiotic activity.

The only doctor I've actually seen publicly advocating the use of sutures in the wilderness also happens to be the medical director of our mountain rescue group, and our new medical protocols do not include the ability to suture wounds in the field. Now, granted, if we're doing a rescue chances are good our patient needing sutures is less than 48 hours from medical care (probably less than 24 or even 12 in this day and age), but none the less...

I think perhaps Brumfield is in a rather unusual position traveling in a country where definitive medical care is quite lacking, and he may be the only person for miles around who has the materials and ability to suture... and I can't imagine a villager making a long trip to a village with a clinic just for sutures...

I'm curious Brum, what is your medical background/training? My dream is to be a traveling medic (in warm climates) after I get my PA degree.

MNS

Hi MNS, my medical training is solely hands on, no schooling. I grew up on a farm in the country, and watched family and friends, a few doctors included, stitch up people and animals often. Somebody would eventually wound themselves while hunting, whether on a barbed wire fence, or mishandling a knife, or tripping and falling on something sharp or pointed. I once watched my uncle sew up a cur dog from rectum to chest, including one intestine, after a big boar hog ripped him open. That actually was a fairly regular happening and I got in a little practice helping out from time to time.

I began carrying a suture kit many years ago after coming across a village child that had been mangled by a dog. She had been given no stitches and horrendous scars were forming. She had just been left to heal without much care and her wounds were infected and still bleeding after nearly a month. I convinced the parents to bring the child to a doctor friend of mine across the mountains. The doctor fussed at me for not being prepared to handle such emergencies on my own, gave me my first suture kit, and about three hours of lessons as he cleaned, debrided, and sutured the child's wounds. I have since studied everything I can get my hands on regarding first aid, field medical treatments, and emergency trauma care.

I did get some medical training through the Coast Guard when I acquired my Captain's License, and I stay current on all Red Cross training. I've only had to use the suture kit three times on others here in Mexico, fortunately not on myself. Medicines here (that are made in the USA) cost about half what you pay in the US. In most of the small villages prescriptions are not needed for medicines and what would be prescription only drugs in the US. The local drug stores are just one room right on the street front with a wooden counter running the length of the room. If you know how to ask for the drugs, or can write the name down, print the info from online, or bring an old bottle, they will sell it to you. I buy and carry syringes, a surgical scalpel, tissue forceps, suture scissors, disposable suture needles, absorbable suture thread, a needle driver, procaine, Novocaine, Lidocaine powder, penicillin, a plethora of prophylactic and oral antibiotics, and pain medications. Not for me, but for villagers I meet.

I have very close friends that are physicians in the states, and here in Mexico, and they are always on standby to answer my questions and guide me, or come to the rescue when I find people in need of major care here. I know more than one doctor that will hike for miles back into the mountains to treat sick or wounded villagers. They are a credit to their profession.

I could never do this in the US, I would be sued to no end just for trying to help in an emergency. It's different here in Mexico. People are grateful for assistance, and are not litigious. I of course recognize my limitations and never attempt any major operation. I'm simply untrained and not qualified. But, treating infections, removing debris from eyes, spiders from ears, treating shock, and stitches ONLY when needed, I can do. I can pull teeth too. Have done that three times so far. Thank goodness there are midwives in every village. Brum

honey, use it all the time for small cuts!!!! been the way to heal cuts and small wounds.. blisters, scrapes etc here in Hungary for a 1000 years or so..

but these days not too many ppl carry the stuff with them on their hiking trips...


robi

Honey? Can you describe how you use it? I've used a mixture of honey and water to 'cure' bagpipe bladders. Nothing grows in the leather after it's treated.


Another vote for superglue......a week ago I sliced my middle fingertip about a 1/4 inch deep and a centimeter long, longways, with a razor knife. Left a blood trail to my house! Debriding with soap and water, and a bit of pressure with some gauze soaked in Betadine stopped the bleeding. Sealed the cut with superglue and added a second coat to the surrounding area. I was back at work in an hour. This was one of my guitar fretting fingers and heavily callused. The cut went all the way through to the bone.
Was playing guitar on stage the next day. It's completely healed now. Great stuff!

I am afraid. And I have an opinion.
I do not trust the pharma industry very much and usually the top people in the FDA are pharma execs - that will go back to Merck or wherever after they have served a tour of duty in the FDA. So I am very skepical - and no matter what approval it gets I would have to wait several years for everyone else to try it out first.
Celebrex - for example. The profits far exceeded the cost of the lawsuits.

I think the idea is a good one and would love to be able to trust it- but I am just not sure.
Also remember that the Military has been used as guinnea pigs for as long as forever and anything that is developed for them can be bad news.

It's funny, there was a piece on the local news last night about what to put on open cuts and what not to. The guy doing the piece is an MD. He was very emphatic about not putting any substances such as butter, syrup, honey, hand lotions, etc. on an open cut. He said you're better off just washing it and covering.

The thing that was recommended is antibiotic ointments specifically for open wounds. If it says on the label that it's not recommended for use on open wounds, don't use it. Care needs to be taken to not overdo it with recommended ointments, just a little dab. Too much keeps the wound from drying and can actually be detrimental.

Good one. More than 100,000 years is my bet. Another good reason to carry honey. I carry at least a 500ml plastic jar of it of it as it is my backup food source in addition to being used for my tea. I probably only average 50ml a day, but what I don't use just goes back on the shelf when I get home.

Advantages of honey:
1. As dense as any other source of carbs, weight wise.
2. Denser than most other sources of carbs, volume wise.
3. Contains natural preservatives and anti-fungal etc. in addition to the sugar itself.
4. Can be used to preserve other foods, and pack them more densely.
5. Natural source of fast carbs if you bonk or get wet or something like that.
6. Taste great, a great sweetener for slow carbs, and tea.
7. Useful as a lip balm.
8. Apparently also useful for minor cuts and abrasions and blisters. Thanks again.

Makes sense. Great stuff.
Thanks for that tip Robi, you wild and crazy Magyar dude. <img src="/forums/images/graemlins/laugh.gif" alt="" />

First I'd heard or using honey. I always use mud.

http://www.mayoclinic.com/health/honey/AN01796

"However, it's important to note that the specialized honey used in wound products and in research studies is different from honey available to consumers. Also, the honey used in research studies has been treated to remove contaminants. It's not clear at this time whether ordinary supermarket honey has the same wound-healing effect."

i have no idea if the honey really works or if it is just a wives tale, but ppl here still put it on small cuts and scrapes. I too do it and have never had any problems. I have tried it on one small cut and left another cut without honey and the honey cut healed faster...

plain old hone, bought from the bee keeper... no special treatment.

robi

In the old day's you would probably be considered a doctor with the knowledge you have. Are you currently on a backcountry mission? If so, please post some info and pics when you return.
Chuck...

A small tube of Neosporin works great to speed healing of wounds. I once cut my finger with a bandsaw while resawing and felt 3 saw teeth bounce of my knuckle. After the bleeding subsided, I started using Neosporin and fresh bandages daily. I should have had a few stitches but it healed nicely and I still have all of my fingers.