Wound Closure Techniques

Bottom line up front: If you are carrying suture kits in your med. kit, you’re kidding yourself. Read on to find out why I say this.

We have to approach wounds in a way that gives priority to taking care of what is most dangerous first, followed by the things that are less dangerous or less time-sensitive. In the context of bleeding, stopping the blood loss is always first because it is the most time-sensitive. In other words, exsanguination (bleeding to death) will kill you first.

After exsanguination, hypovolemia (low volume) can lead to another dangerous condition known as hypovolemic shock. Hypovolemic shock is a life-threatening condition in which there isn’t enough volume for the heart to supply your body with blood. This can lead to organ failure.

Prevention of shock is the secondary concern after controlling the bleed. You’ll notice that prevention of infection by cleaning the wound and taking steps to promote healing and lessen the scarring are not the priority. These are less of a concern in the short-term.

Once the bleeding has been stopped and you have prevented exsanguination and hypovolemia, then you can worry about those tertiary concerns. Infection can take days to become an issue, and by then you will hopefully have made it out of the field and to an actual medical facility. Whatever caused the wound to begin with, was likely dirty, and you are likely to need antibiotics regardless of what you do after. How dirty was that knife, axe, or bullet that went through?

The priorities for a major bleed:

  • Control the bleeding.
  • Prevent and/or treat hypovolemia and hypovolemic shock.
  • Prevent infection; promote healing; lessen scarring

It is important to make the distinction that I am talking about actual life-threatening bleeds with a high- to medium-volume of blood loss.

I am not talking about smaller bleeds that are easily controlled that don’t result in much blood loss. By all means, clean them up and dress them as needed. These would never result in exsanguination or hypovolemia, so taking the time to prevent infection is perfectly appropriate. That isn’t what this article is about.

I point this out so that you can apply some critical thinking to your medical kits. Many of the commercial “first aid” kits are for the low-volume, less dangerous injuries. Many are full of things like band-aids, alcohol wipes, and triple antibiotic ointment. Understand that anything these items will fix was never going to kill you anyway. None of them are actual emergencies.

Does your medical kit have anything in it that is sufficient to control a major, life-threatening bleed? Can it handle a major bleed to the extremities or junctional areas? You don’t really need to worry about preventing the infection to a lifeless body.

If you do not have the supplies to intervene with wound packing, pressure dressing, and a tourniquet (not necessarily in that order), your kit is not sufficient enough to handle a life-threatening bleed. You will be forced to improvise when seconds count in a life or death situation. This is the opposite of preparedness; this is reactiveness.

With any luck, that will give you some context leading up to what I am going to recommend to you: stop carrying the suture kits as if you or someone else are going to use them for a “bleeder” in the field.

Not only do you not have the knowledge or experience, sterile environment, good lighting, and anesthetics like you would if you were a medical professional in a clinical environment, it is also not necessary for the field environment.

Superficial suturing is not a method of controlling a life-threatening bleed. You aren’t just going to “sew-up” a high- to medium-volume bleeder that is actively gushing or spurting blood. Lets apply some critical thinking to this again: our blood is pumped by the heart through vessels to the rest of the body. The blood is not contained under the skin as if we are a “bag of blood”.

You can’t just close it up like you are patching a tire. It has to remain in the actual vessels to be delivered. If you cannot locate the ruptured vessel or vessels and directly sew or tie them shut, you did nothing to stop the blood loss from that vessel.

That works about as well as a strip of duct tape to cover the wound. Out-of-sight, out-of-mind doesn’t work. If it did “work”, the bleed was never serious. If you have sutured yourself in the field and it worked, the injury was never that much of a threat anyway and the sutures weren’t necessary.

Sort of like drinking urine, nobody survives because of it; they were going to survive anyway. Superficial (dermal) suturing is a way to bring the edges of the skin back together to promote healing and lessen scarring. It also keeps the wound closed to help prevent infection (it keeps more junk out).

It is not a method of controlling a bleed in the field by laypersons. These things are tertiary concerns and not something that is a concern in the field. Not to mention, folks without the proper training and facilities will cause my injury to themselves or others and drag more junk into the wound than if they had just left it alone; all for an intervention that was never needed in the first place.

Once you do get the bleeding under control, if you want to close up the edges of the wound to promote healing, lessen scarring, and keep some of the junk out, there are appropriate ways that this can be done.

This can easily be improvised using multi-use items because it is not critical and not time-sensitive. Some duct tape, bank line, and a canvas sail needle can be all you need for this.

Save your suture kits for gear repair in the field.

Watch this video to learn this technique. Click HERE

If you don’t have a kit that can actually handle a life-threatening bleed, I recommend carrying the M-FAK (Mini First Aid Kit) at a minimum

Get ready to learn this and so much more when my Wilderness Medical Films drops on Tuesday, April 7th! Join my email list to be notified when it launches.

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About Joshua Enyart

Joshua Enyart is a former Army Ranger and Green Beret specializing in emergency and tactical survival, bushcraft, and preparedness, primarily in the Woodlands and Mountains of the Eastern United States.

Joshua Enyart is the Founder and Lead Instructor for Flint & Steel Critical Skills Group, LLC and is an Instructor for the Pathfinder School, LLC, and is an Instructor for Prepper Advantage.  Joshua has also been a contributor to both ReadyMan and the American Protection Alliance, and has been a speaker at the Prepper World Summit.

He has completed several military schools including Ranger, SERE Level-C (Survival, Evasion, Resistance, and Escape), Special Forces Qualification Course (Weapons), Special Forces Sniper Course, and trained as a Combat Hunter (Tracker).

Joshua completed a total of 11 Combat Tours in Iraq and in Afghanistan (as both Active Duty and as a Private Contractor) where he was awarded several medals including the Bronze Star. He has also been to the Jungle Operations Training Center in Panama (Central America) three times.

Joshua is a seasoned instructor that has completed both the Army Instructor Training Course and the Air Force Basic Instructor Course. He served as a senior Pre-Ranger Instructor for the 101st Airborne Division, Weapons and Tactics Instructor for the Air Force Special Operations Command, and a Sniper Trainer and Ground Warfare Instructor for the Marine Special Operations Command.

He is also an Emergency Medical Technician and a Junior in college majoring in Biology, working towards Physician’s Assistant School.

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