Thursday, August 31, 2017

Suture (stitches) and wound care...

By: Sebastian Berry

As with all my articles...

DISCLAIMER: Instructions and information here is not a substitute for professional medical care and treatment. If you are having an emergency call 911 or your local emergency number for assistance.

I do not claim credit to any of the images used unless specifically indicated. All rights and credits remain with the original owners

My apologies to our faithful readers and staff here at Family Survival Farm. I have been away taking care of some family things that came up, namely my wife having surgery. For me, this is a very timely and appropriate topic.

About four months ago my wife began to complain of elbow pain in her left elbow that ran down her arm. Being who I am I dismissed this as overuse with the baby and told her to take some Tylenol and ibuprofen and learn to switch arms when carrying the baby.

About three weeks ago the missus complained again about her arm hurting more consistently from the left elbow through the left hand and having numbness and tingling in the fingers of the left hand. Again, being who I am, she didn't get a choice about going to go and see the hand surgeon.

Now she and I both have suffered from carpal tunnel syndrome. If you don't know what that is you can find out here. Essentially it is a compressed nerve in the hand/wrist that causes numbness and tingling. A contributing cause to this injury/syndrome is repetitive work, such as manufacturing assembly lines, farming, mechanical, building, and typing. Go figure, I have done all of these, it's no wonder that I had carpal tunnel release surgery completed on both hands in my early thirties.

Back to my wife though, her issue was not simply carpal tunnel syndrome. Her condition was complicated with the addition of cubital tunnel syndrome, which you can read about here. Long story short, similar symptoms in a different spot with relatively the same cause-repetitive use.

From her appointment, to testing, then to surgery was less than a week. From surgery to follow up was almost two weeks to the day. While dear wifey was recovering, I had full control of the house (insert maniacal laugh here). This is where we get into the meat and potatoes of my topic.

My wife, much like every other woman in the known universe, has her quirks and intricacies. One of those is post-surgical recovery. I was faithful at her every request to check her bandages and re-wrap them as they shifted. Elbow bandages do not stay in one place. She was insistent to make sure that her surgical sites were appropriately bandaged and cared for and that they did not "open up".

Typically speaking, sutures (stitches) and staples of almost any flavor stay in for 7-10 days and are then removed. 7-10 days helps to ensure full closure and decreases the chance of dehiscence (opening up). There are some things that we have to do on our end though...
  • clean and dry for the first 24-48 hours
  • avoid use/overuse while sutures are in place
  • application of antibiotic ointment
  • use of steri-strips to reinforce sutures and wound approximation (how it lines up)
  • on time removal of sutures
Generally speaking, clean and dry means exactly that. Depending on the location of your wound and sutures, you may be able to shower with a little extra precaution. You also might not be able to fully bathe for those first 24-48 hours. After the first day or two you should be able to shower and clean normally. The caveat to that though is that you should not soak or submerge the site, i.e washing dishes or sitting in a hot tub. Allowing water from the shower or from washing to run over the site is totally fine and appropriate, just don't scrub the site while washing. When you dry off you'll pat dry, DO NOT RUB AND DO NOT USE A HAIR DRYER. Most suture material is made of nylon and what happens to nylon when heat is applied? Oh yeah, it shrinks. I kid you not, this is something I include in patient teaching in the emergency room.

Imagine for a moment shaving with a dull and dry razor. You would get a lot of tug and pull and it would be very uncomfortable. Imagine putting a dry dressing over your wound site and sutures, same thing happens-lots of tug and pull and being uncomfortable. Obviously if you are in a family survival situation you may just have to put up with being uncomfortable. The dressings that I apply in the emergency room have several parts.
  1. Antibiotic ointment- I always recommend ointment + pain relief. It only costs a little bit more and is worth every penny.
  2. Steri-strips with skin prep adhesive
  3. A non-adherent dressing- This includes telfa (the pad on a band-aid) and adaptic (petroleum gauze)
  4. Dry gauze
  5. Tape or coban
The dressing should stay in place for the first 24-48 hours. Coincidentally this is also the amount of time we ask people to keep their injury clean and dry.

After the first day or two, we can imagine the tasks and chores that have piled up on your family survival farm. In many instances, you'll be able to return to limited work and play. My instruction to my ER patients is rest as needed and activity as tolerated. This is always dictated by the situation, please make sure to follow the direction of your medical provider. Steri-strips should be allowed to fall off on their own as time elapses.

After 7-10 days usually your sutures can come out. I'll tell you that it's not rocket surgery. If you have any hesitation about taking out your own sutures you should see your medical provider. Notice, I'm not giving any instruction on how to take them out yourself. Seek the guidance of your medical provider.

After your sutures come out, are you done? No not really. Now you have an area of skin that requires some extra attention in order to return to its full and healthy state. You probably won't need to continue applying antibiotic ointment. Now you can start to use your normal moisturizers and creams. I always recommend to folks to use something with vitamin E and for folks to use sunscreen on the affected area for six months or more in order to reduce scar prominence. It is very common for wound sites to have dry skin. You can't overdose on plain lotion with vitamin E, use it as often as you like.

Back to my wife. By virtue of having an ER nurse at her beck and call, her wounds healed very well. I'll give some credit where due though, the surgeon did an impeccable job with his suturing technique and provided a very well done closure of the surgical sites on her left hand and left elbow.

Credit: Sebastian Berry

Credit: Sebastian Berry

A special thank you goes out to everyone that helped my little survival family. Many small favors and friendly gestures were received and our hearts were full from the outpouring of love and support from family, friends, and neighbors.

What things do you do for your ouchies? Sutures, tape, glue? Let us know in the comments...