Suture Kit?

I'm trying to track down a suture kit to add to my medical bag. I'm trained and know how to use one.

What are the best suture kits you've seen? I'm thinking I may be better off cobbling together my own...
 

El Solis

Adventurer
I just put my own together (perk of being a surgeon) but I find that it would take a special situation to suture a wound in the back country. Infection being the big worry. It came in handy Christmas morning when I sutured my father in law's finger tho. Saved many hours at the ER.

Sutures I carry as an FYI:
2-0 and 3-0 vicryl/polysorb
2-0 and 3-0 silk
0 tycron (super heavy duty)
2-0 and 3-0 nylon
Staples
(I have 4-0 monocryl/biosyn for "pretty stitching" but wouldn't use it if I was worried about infection or if the victim had to move the affected part)

I have generic needle driver's and forceps (adson's) just because i don't mind using them.

More important is ability to clean the wound (I used betadine, water and chloraprep) and to numb it (1% lidocaine with epi).
 

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Thanks guys, I think I'm going to cobble one together over the next few weeks.

El Solis, great list. My dad used to be a doc and he's recommended several of the same.

Thanks!
 

Arclight

SAR guy
I would add that you want a large syringe (60cc or more) and some Betadine to thoroughly flush those wounds. You can get a bottle of generic contact-lens saline instead of wound-irrigation saline. This is a nice item to have on a vehicle, as it's cheap and doubles as an emergency eye wash. Just make sure the only ingredient is saline.

The wilderness EMT classes often teach that using clean drinking water is OK if no saline is available. You can also use a weak Betadine solution (think iced tea color) to flush dirtier wounds. Dirty wounds include animal bites (including human) and anything obviously contaminated with dirt, etc. The key is pressure - you want to blast out those embedded bacteria and dirt particles.

You might also want some Steristrips. You can use these for wound closure by themselves, or to protect those sutures from pulling out. They stay on much better (especially around water) if you prep the skin with Tincture of Benzoin. I recommend the ampules for this. The swab stick seem to like breaking open inside wilderness kits and make a real mess.

For the lidocaine, remember that it comes in two flavors - with and without Epinephrine. When I see suturing done at the hospital, the epi-type does a good job of stopping up the bleeding so you can see what's going on. However, it's dangerous to use on fingers, toes, nose, penis, ears as it, well shuts off the blood.

I'm just an EMT with some additional wilderness training, so I'd certainly defer to the pros for more details.


Arclight
 

86tuning

Adventurer
I've seen and used spray cans of saline which are super handy for washing stuff. A big spray can of contact lens saline is cheap and there's lots in there.

And I've always just used micropore tape to close really small wounds instead of steri-strips.
 

mep1811

Gentleman Adventurer
Suture kit

You can get a stapler kit.

http://www.amazon.com/Surgical-Disposable-Sterile-Enhanced-Preloaded/dp/B002OMA99O/ref=sr_1_3?ie=UTF8&qid=1362713997&sr=8-3&keywords=suture+kit

http://www.amazon.com/Survival-Surgical-Suture-Emergency-First/dp/B005CQBR6S/ref=sr_1_2?ie=UTF8&qid=1362714158&sr=8-2&keywords=suture+kit

Rather than carried heavy and expensive bottles of saline solution you can just use clean water and sterilize it with a steripen.

Steristrips might be a better option as they do not require special training to use as well as not needed a local anesthetic to apply unlike a suture would.

Best to stay in your lane when to comes to first aid and medical experimentation on injured humans.
 

spunky2268

Adventurer
Well, opinions are like a******s, and I have (am) one of those, so I'll chime in too. Having closed wounds on search dogs and search humans in austere conditions, my preferred setup would be something like this, cobbled together from items I am comfortable with:

First, I'd rather not close a wound on a trip... But, if necessary, I'd start with something to irrigate wound. Saline is fine, but bottled water, or even tap water will do. There's literature that abounds on wound irrigants, and none support any of the fancy stuff (betadyne, Shur-clens, prayer). Saline can be made in the field if needed, but copious irrigation is key. Take a pocket knife, punch a hole in the cap of a water bottle and viola! Instant irrigation setup.

Second, don't skimp on instruments. Nothing is worse than having to sew at night, by flashlight or headlight, in the cold rain if your suture material keeps getting hung up in those cheap, disposable instruments. If you want to go disposable, spend the extra money and get a quality set.

Third, purchase or appropriate the material you are most comfortable with, keeping in mind what you will want to repair in the backcountry. I am not comfortable doing multiple layers or absorbable sutures and would prefer to evacuate to a hospital. Let's face it, if you planned your trip well (at least CONUS), you will have an idea where hospitals in your area are, even if they are an hour or few away. Consider tissue adhesive, as well. The safety & health Nazi's will have my head if I suggest Super Glue, so I won't.

Fourth, get Trott's book, "Wounds and Lacerations: Emergency Care and Closure". Read through it and think about what wound closure challenges you want to take on in the woods.

Fifth, practice lots with what you've chosen, in your percieved level of austerity. Buy an extra pack of hotdogs to take with you on your trip and practice sewing them up. As an aside, a subungual hematoma can be a trip ruiner. You can practice relieving these by gluing or inserting Lee Press-On nails into the weiners, injecting a little ketchup under the nail and go to town with a red hot paper clip.

All that said, I no longer carry sutures or staples for personal/group trip use in the backcountry. Not comfortable doing that in today's society. I am not a surgeon or a physician, just a lowly RN/paramedic/US&R Med. Spec. with enough knowledge to be dangerous. If I'm sewing wounds, I have a doc either at my side, or on the radio. I carry Steri Strips and benzoin for myself, family and friends.

Probably more info than you wanted, but I'm going on an hour's sleep after a busy night in the ED and get wordy when I'm tired.
 

w.rwlnd

New member
Just buy a small staple gun for emergency use. It is actually cleaner when used in the back country. I got mine during a Gun and knife show (they like to be prepared?)
 

El Solis

Adventurer
staples are really good for scalp wounds, almost don't even need to wash them (they bleed like stink so speed helps, staples are fast). As a trauma surgeon who sutures literally daily, as I said earlier, I really would think twice before suturing in the back country. If it was a smaller laceration and it would mean ending a trip, sure. Big a larger laceration, it really would depend on the situation. Wash and cover with clean gauze and pressure (ace wrap or my favorite coban, more elastic) would really be the way to go, even for trained professionals. Consider this: even in the operating room, under sterile controlled conditions AND patients are given IV antibiotics prior to surgery there are still wound infections, so probably an infected wound closed in the the back country probably has little chance to not be infected. So lots of clean water, lots of gauze and coban/ace wraps and you are good to go.
 

Arclight

SAR guy
I'm not sure what the original poster's need was, but I can think of 3 cases:

1. Managing wounds received in the field. This is where good cleaning, pressure dressings and steristrips are most appropriate.
2. Your travel or work takes you to places where you might need to get treated at a village clinic or a disaster relief site. Bringing your own sterile supplies improves your chances of getting treated right now and having a good outcome. It also avoids burdening the local team.
3. You run dogs or other animals that don't know how to be gentle with bandages. This is a whole 'nother topics in itself.


Arclight

I'm curious, what sort of training advocates suturing in the field?
 

Youngunner

Adventurer
The vast majority of suture jobs outside of the hospital I have seen are accompanied by nasty infections, despite thorough irrigation. If absolutely necessary I would opt for a loose "stitch" job or even just good ole butterflies and frequent dressing changes en route to civilization. Same priciple as an "incision and drainage" for those familiar with the procedure. Antibiotics are a whole other debate with me given the over-usage in our society, but in the case of back-country injuries, I'm in favor.
 

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SOFME

Observer
Well, opinions are like a******s, and I have (am) one of those, so I'll chime in too. ... I'd rather not close a wound on a trip ... Take a pocket knife, punch a hole in the cap of a water bottle and viola! Instant irrigation setup... purchase or appropriate the material you are most comfortable with... The safety & health Nazi's will have my head if I suggest Super Glue, so I won't... practice lots with what you've chosen, in your percieved level of austerity. Buy an extra pack of hotdogs to take with you on your trip and practice sewing them up... I no longer carry sutures or staples for personal/group trip use in the backcountry. Not comfortable doing that in today's society...
100% agree with this.
honestly I can't think of any lacerations which would REQUIRE sutures in the field. (Just because you can doesn't mean you should) no one dies from a bleed that is remedied best by suturing (unless of course we’re talking about minor vascular surgery).
As stated before in this thread risk of infection is too high. In my experience I have only sutured in the field if I could provide prophylactic antibiotics. Beyond that the best treatment is to stop the red stuff coming out, keep it clean, keep the patient warm, and get them to higher care.
 
I'm curious, what sort of training advocates suturing in the field?
Thanks for the feedback, guys. My work takes me into a host of third-world situations, including disaster response situations and medical aid - of any sort - is often more than five hours away. I'm well aware suturing in the field is not the best idea... trust me, I don't want to wield a needle if I don't have to, but wanted this skill in my repertoire in a worst-case scenario situation. Fingers crossed the equipment will go untouched!
 
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