American Partisan: Ditch Medicine – Laceration Management

From the medical staff at American Partisan is this primer on the care of lacerations in austere conditions, Ditch Medicine: Laceration Management.

Lacerations are trauma which result in cutting or tearing of skin and possibly underlying tissue. Please note that deep lacerations that are complicated by the involvement of injuries to major arteries, tendons, nerves or abdominal cavity contents are not usually treatable in primitive conditions.

Initial Care for Lacerations

Most bleeding is initially controlled with pressure. Wounds without deep involvement should be surgically repaired if possible to speed healing, reduce infection, and improve cosmetic and functional results. The approximation of the skin edges can be achieved with steri-strips, skin glue, staples, or sutures (stitches). Before any wound is repaired, a few simple rules should be understood.

  • The longer a wound is left open to the environment, the more bacteria it will collect and therefore has a greater chance of infection, especially if the wound is closed by trapping these bacteria within the wound.
  • Most wounds can be closed within 12 hours of the injury (since the bacteria count won’t be terribly high). Since the face and neck have increased blood flow compared to most other body parts this extra blood flow helps the wounds fight infection and promotes healing, therefore wounds to the face and neck may be closed up to 48 hours after the injury.
  • Wounds that are to be closed must be thoroughly cleaned of any debris using forceps (tweezers) and using generous washings with clean or sterile water or saline. One source suggested using fresh urine from person without urinary infection since that should be sterile (I think I would rather use boiled water).

Creating Saline Solution for Laceration Washes

Saline solution can be made by adding one tablespoon of salt to 1 gallon of water or adding 1 teaspoon of salt to 1 L of water. Another irrigation solution can be made by adding 5 mils of household bleach to 1 L of clean water. Washing the area with Betadine or hibiclens before closure should be performed. Ragged wound edges and the tips of angularly cut tissue should be removed so that the wound edges to be approximated are smooth and will be likely to heal.

Steri-Strips, skin glue, and sutures may be the most useful ways to close a wound in a primitive environment. Staples may be used but require removal with a specialized removal tool which may not be readily available. Steri-Strips (tape) and skin glue can be applied to many wounds to hold the skin edges together until healing occurs. These are less secure than sutures (especially in larger deeper wounds) but maybe faster, require less technical skill, and may offer an improved cosmetic result.

For larger deeper wounds, sutures may be best for closure. Some wounds may have skin loss such that closure of the skin edges may be under some tension. The strength of sutures would be better for that closure, over glue or Steri-Strips. Sometimes tissue loss may be extensive enough that complete skin edge approximation may not be successful. Some gap in the skin edges may be allowed in these circumstances. Tissue loss with tension on the closure would require that the sutures be left for a longer period of time until the skin has stretched and relaxed enough so that there is no significant tension at the wound before removal of the sutures. In wounds without tension on the face, the sutures may usually be removed in about 3 to 5 days (this rapid removal is because of the high blood flow which speeds healing). The sutures on wounds of the trunk without tension may be removed in about 10 days. Sutures in the hands and feet are usually removed in about 10 to 14 days…

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