Wilderness Medical Series — Module 07

How to Clean and Close Wounds in the Field

Wilderness wound care after bleeding is controlled — wound irrigation, field closure techniques, and daily wound management in multi-day scenarios.

By Joshua Enyart · Founder & Head Instructor, Gray Bearded Green Beret

Former Army Ranger, Green Beret, and full-time survival instructor · three decades of professional instructor experience

Once hemorrhage is controlled, the management of a wound shifts from stopping blood loss to preventing infection. In a hospital setting, that shift happens in a sterile environment with access to irrigation systems, antiseptics, suture materials, and antibiotics. In the field, it happens with what is in the kit and what can be improvised from available resources.

Field wound care is not hospital-quality wound care. It does not need to be. The goal is to reduce the bacterial load in the wound, provide protective coverage, and maintain that coverage through daily management until the patient reaches definitive medical care. This article covers how to do that with the tools and materials available in a wilderness setting.

The Secondary Concern Before Wound Work: Shock Watch

Before moving to wound cleaning and closure, complete the shock assessment. Significant bleeding — even controlled bleeding — can leave a patient with reduced blood volume that tips into hypovolemic shock in the minutes after hemorrhage control.

The six indicators of hypovolemic shock are: elevated heart rate (above 120 bpm), decreased blood pressure (indicated by a weak radial pulse), rapid breathing (above 30 breaths per minute), pale and cool skin, cyanosis around the lips, and altered mental status. Any one of these indicators warrants immediate shock treatment before wound care.

Shock treatment takes priority. A wound that is properly covered for thirty minutes while you treat shock is a better outcome than a beautifully irrigated wound on a patient who deteriorated while you worked on wound care. Sequence matters.

Wound Irrigation: The Primary Infection Prevention Technique

Irrigation — flushing the wound with clean water — is the most effective field technique for reducing bacterial contamination. It is not glamorous. It does not require special equipment. It works.

The goal of irrigation is to mechanically remove debris, bacteria, and contaminated material from the wound. The water does not need to be sterile, but it does need to be clean — disinfected by boiling, chemical treatment, or filtration. Using contaminated water to irrigate a wound introduces a new infection risk rather than reducing the existing one.

Field irrigation technique: Hold a full water bottle high above the wound — at least a foot of elevation — and pour water steadily over and into the wound. The height creates pressure that carries debris out of the wound rather than just washing the surface. Work from the cleanest area to the most contaminated.

Volume matters. A single quick pour does not adequately irrigate a significant wound. Keep irrigating until the runoff from the wound runs clear. If the wound is deep, use a syringe if available, or improvise pressure by puncturing the cap of a water bottle with a small hole. Directed pressure irrigation is more effective than open-pour irrigation on deep wounds.

After irrigation, the wound should be cleaned around the edges with soap and water to reduce surface contamination before covering.

Field-Expedient Wound Closure

Wound closure in a field setting is a limited technique compared to clinical closure. Sutures — the gold standard in a hospital setting — have almost no place in wilderness medicine. Sutured wounds that are contaminated — which most wilderness wounds are — trap bacteria inside and dramatically increase the risk of serious infection.

Closure strips made from duct tape are the most practical field closure option. Cut small, narrow strips and apply them perpendicular to the wound margins, pulling the edges together without creating dead space inside the wound. Do not close the wound completely if there is any doubt about contamination — leave a small gap for drainage.

A more involved technique for wounds where the edges need to be drawn together more precisely is the sewing technique: take thin strips of duct tape and attach them parallel to both wound margins, leaving the wound itself uncovered. Run a piece of thread or paracord laced between the strips to draw the margins closer together — like a corset lacing pattern. This distributes the tension across the strip rather than concentrating it at a point, which reduces tearing.

Wound closure with either technique is appropriate for lacerations that are clean, have straight margins, and have been thoroughly irrigated. Wounds with ragged margins, contamination that cannot be fully removed, or wound depths that prevent visual inspection of the cavity should be covered and dressed rather than closed — drainage needs an outlet.

Puncture Wounds: What Not to Close

Puncture wounds are specifically contraindicated for field closure. A puncture wound is narrow at the surface and potentially deep and wide internally. Closing the surface entry point traps contamination inside the wound channel where it cannot drain and where irrigation cannot reach it.

Cover a puncture wound with a clean dressing after irrigation and leave it open. In the field, the primary concerns are preventing further contamination of the surface and maintaining the dressing. Closure is a decision for medical personnel with proper assessment tools and imaging capability.

Covering the Wound After Closure

Whether closed with tape strips or left open for drainage, every wound needs a protective cover that is changed regularly. The dressing keeps environmental contamination out, reduces moisture loss from the wound surface, and provides a consistent baseline for reassessment.

Use a non-adherent dressing directly on the wound if available. Non-adherent material does not stick to the wound bed during the clotting and healing process, which means changing the dressing does not re-injure the wound. When non-adherent material is not available, lightly moistened gauze reduces adherence compared to dry gauze directly on the wound surface.

Secure the dressing with tape on dry skin. In wet conditions where tape will not adhere, a cravat wrapped around the limb and tied securely can hold a dressing in place. The dressing must stay on the wound — a dressing that falls off or shifts leaves the wound exposed.

Daily Wound Management in Multi-Day Scenarios

In a multi-day wilderness situation, wound management is a daily task. It cannot be applied once and left for the duration of the trip.

Re-irrigate, clean, and redress the wound at least once per day. More frequent dressing changes are appropriate if the wound is in a location subject to heavy contamination — a hand wound during campsite work, a foot wound during hiking. Any time the dressing becomes saturated, soiled, or displaced, change it.

Assess the wound at each dressing change for signs of infection: increasing redness extending beyond the wound margins, warmth, swelling, purulent discharge, or the patient reporting increasing rather than decreasing pain. Infection developing in the field is a signal to accelerate evacuation.

Monitor the patient's systemic condition alongside the wound. A low-grade fever, general malaise, or increasing heart rate without an obvious cause may indicate developing systemic infection — sepsis begins with a local wound infection that the body cannot contain. These are evacuation indicators, not wait-and-see indicators.

When to Accelerate Evacuation

Wound care in a multi-day wilderness situation is management, not treatment. The field provider keeps the wound clean, protected, and monitored. The actual treatment — debridement, antibiotics, closure, assessment of healing tissue — happens at a medical facility. The goal in the field is to deliver the patient to that facility with the wound in the best condition possible and without unnecessary deterioration.

Infection indicators that warrant accelerated evacuation: redness spreading beyond the wound margins (cellulitis), warm skin around the wound site, purulent (pus) discharge, the patient reporting increasing pain rather than decreasing pain over successive days, or any systemic signs — fever, elevated heart rate, general malaise — that suggest the infection has moved beyond the wound into the systemic circulation.

Systemic infection (sepsis) is a life-threatening condition. In the field, the indicators are subtle early and severe late. A wound that was clean on day one and is producing systemic signs on day three is a wound that has outpaced field management capability. Do not normalize progressive deterioration — compare the wound daily to its condition the previous day, not to what a healthy wound 'should' look like.

The right mental model for field wound care: you are buying time. Every clean dressing change, every irrigation, every daily assessment extends the window for safe evacuation. The wound does not need to heal in the field. It needs to not worsen in the field. That is the standard you are working toward.

Communicating Wound Status at Handoff

When evacuation arrives, the wound history is part of the handoff information. Communicate the mechanism of injury, the initial wound condition, what treatment was applied (irrigation volume, closure technique, dressing type), the date and time of each dressing change, and the current wound assessment — redness, swelling, discharge, odor, patient-reported pain trend.

A receiving provider who knows the wound has been irrigated daily, is showing no spreading redness, and that the patient reports decreasing pain can triage the wound to secondary priority. A receiving provider who receives the patient with no wound history needs to start from scratch. The information you document and communicate directly affects the speed and quality of care the patient receives at handoff.

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