Ask Doc: What Kind of Suture Kit Should I Get?

This is a somewhat frequent question and related to misconception that suturing is one of those highly necessary skills. It looks sexy, creates cool scars and stories, and let’s face it, makes you seem like an “experienced” medic.

Time for the bubble to be burst. Sutures are nothing more than a lazy bandage. That’s right, a suture is a bandage. It’s primary purpose is to prevent further contamination from entering a wound. It can also somewhat help with the remnants of wounding–namely scarring. Does it promote more rapid healing? Well, not really (some caveats here; outside the scope of this post), aside from reducing the effect of contamination and potential reopening of the wound. A good primer on the wound healing process can be found here:

http://highered.mheducation.com/sites/dl/free/0078022649/998035/Prentice15e_Chap10.pdf

Wounds take a LONG time to fully heal. Literally weeks to years. If you’ve ever gone to a doctor and had sutures placed, how long do they stay in? Several days, to maybe a couple of weeks.

In the context of the backcountry or some SHTF scenario where you may not have good access to sterile fields and antibiotics (assuming you know the correct ones to take along with the correct doses), suturing can be dangerous. If you fail to perform good and detailed wound cleaning (fully cleansing the wound of all contaminants) all you are doing with sutures is creating a nice snug hotel for infections to take root. Ask any of my students about their wound cleaning lab, how long it takes, and the amount of discomfort you are going to put your patient through in absence of good local anesthetics. Also suturing is a perishable skill. That takes a lot of practice to do right, and to do well. Doing good sutures requires both your hands, and both to be steady. And you need to be able to approximate the wound edges (fancy medical-speak for bringing the edges back together).

You can generally forget those grand ideas of suturing yourself. Maybe you can get away with it on your lower limbs (or chest and abdomen). Factor in stress and pain, and the reality is that you are going to do more harm that good. More than likely you will end up having done something completely ineffective after causing more pain, with further potential for infection. Are there some “Tier One Operators” that can pull it off? I’m sure there are. If you want to find out if you have what it takes, go buy a suture kit on Amazon and give it a try on yourself in optimal conditions. Go ahead, I’ll wait. 🙂

You can apply most of the same reasons to the use of staples (though at least those take much less skill to place). With staples you still have to pull the edges of the wound together before you place them (opposed to suturing where you can get away with more distance at first).

Buh, buh, Tom, what should we do then? Well, I’m a much bigger fan of steri-strips. They are light, strong, and easy to place with little skill. You don’t need extra tools. You don’t need lots of training. They don’t cause further pain to your patient (or yourself). You can easily remove them or put additional ones on with little fuss. And you can put them on most places you can reach with one hand (and once you have good adhesion on one side of the wound you can pull the wound somewhat closed). I know, I know, not very sexy. But neither is dying from sepsis. You still need to clean the wound correctly.

And that said, before you even think about closing a wound, you should invest some time in learning how to appropriately clean wounds, especially in the backcountry. Which would probably make a good post here.

Mandatory Disclaimer (so none of you run off and start pretending to be medics): This article is not a replacement for actually receiving training. It is for your own personal knowledge and is based on best practices and standards of training.

If you have a burning question about a wilderness medicine related concept, feel free to send an email to docrader.tfb@gmail.com. I will pick a question (or two) each week to discuss. You can read about my background below.

Thanks to Brett C. for asking this question!  It is one I do get fairly frequently, and one that definitely can use some clarification.

Doc Rader

Tom is a former Navy Corpsman that spent some time bumbling around the deserts of Iraq with a Marine Recon unit, kicking in tent flaps and harassing sheep. Before that, he was a paramedic somewhere in DFW, also doing some Executive Protection work between shifts. Now that those exciting days are behind him, he has embraced his inner “Warrior Hippie,” and assaults 14er in his sandals, and engages in rucking adventure challenges while consuming copious water. To fund these adventures, he writes all manner of content (having also held editor positions at several publications) and teaches wilderness medicine and off-road skills. He hopes that his posts will help you find the gear that will survive whatever you can throw at it (and the training to use it). Learn from his mistakes--he is known (in certain circles) for his curse...ahem, ability...to find the breaking point of anything. You can follow him at https://linktr.ee/docrader.