since when?

Discussion in 'Survival Medicine' started by monkeyman, Sep 10, 2006.


  1. monkeyman

    monkeyman Monkey+++ Moderator Emeritus Founding Member

    I supose this is as good of place as any for this.

    I was working in the kitchen at work today for the first part of my shift and fileted my finger. I cut about a 3/4" square of skin loose along 3 sides just pretty much between the skin and meat. I went ahead and finished my shift atthe register and after work went to the hospital to have it sewd shut since it would still flop open if the bandage was off and I moved the finger. The Dr. informed me that they couldnt do anything since it had been over 6 hours, which it had happened around 3 PM and he saw me around 12:30 AM and proved he couldnt even count when he tried to say that made it around 12-13 hours, but I know when I have had to get sewed up before it was often over 6 hours by the time the did the sewing. Granted most of those times the last 3-4 hours were in the ER waiting to see a Dr but I was just wondering if anyone knew when they came up with this new idea? Also if it cant be sewed back together/shut then wouldnt that imply that the tissue was no longer viable (i.e. dead) and would need to be removed as necrotic tissue to prevent gangreen and such?

    All they did was have me soak it in betadine for 10 minutes then put a bandage on it. While Im not thrilled anyway I know if I didnt have insurance and had to pay out of pocket for that I would have been thouroghly PISSED.

    I was just wondering if anyone had heard anything about this or if he was just as much of an idiot when it came to medicine as he is when it comes to math.
     
  2. RightHand

    RightHand Pioneer in a New World Moderator Founding Member

    Wound Closure

    The goals of wound closure are tissue repair, recovery of function, prevention of infection, and restoration of appearance. Primary wound closure is most successful when accomplished within 4 to 8 hours of injury; however, the site of the wound, amount of tissue damage, and degree of contamination are factors that influence outcome.

    Delayed primary closure is a technique best used for wounds at high risk of infection, such as heavily contaminated wounds, wounds from animal or human bites, and wounds with delayed presentation. Please note that there is no absolute time limit for wound closure; the location and degree of vascularity determine the time limits for closure. For example, scalp and face wounds heal well even when closed more than 24 hours after injury, but lacerations involving an extremity are more problematic if closure is delayed.

    For delayed primary closure, the wound should be cleansed and left open, then covered with a moist dressing and closed in 4 to 5 days. Immobilization is warranted for wounds involving an extremity. Patients who are reliable and agree to delayed closure should be prepared for the fact that, even after 4 to 5 days, the probability of infection or the state of the tissue may require that the wound be allowed to heal by secondary intent (granulation without mechanical closure).

    Again, although time limits for primary closure have been taught, there are no absolute limits prohibiting primary closure as long as the clinician carefully cleanses and inspects the wound before deciding whether to close it.
     
  3. poacher

    poacher Monkey+++ Founding Member

    MM
    Sorry to hear about the cut. Those are the ones that really suck. Righthand nailed it with his post. While you could still try and get it sewn up at this point I don't know if it's worth it. I would say to keep some triple anti. on it and keep it covered with a bandaid, change the bandaid regularly during the day and keep an eye on it. If there are no mitigating factors such as diabetic or somthing like that you should be fine. Keep in mind that this is just my opinion and if you have any questions go back and see your Dr. again.
    Keep a close eye on the wound for infection and definitly wear gloves when you are dealing with any other slaughtering. Keep us posted on how it's healing.
    Take care Be safe Poacher.
     
  4. phishi

    phishi Psy-Ops Moderator Emeritus Founding Member

    MM,

    Both Righthand and Poacher are correct. IMO I would not have closed the wound due the circumstances under which it happened. That wound has a high potential to be infected, and as such should be cleaned, dressed and observed for signs of infection. That flap of skin will die and fall off eventually, be carefull not to take good skin with it does.

    Hope this helps,
    phishi
     
  5. monkeyman

    monkeyman Monkey+++ Moderator Emeritus Founding Member

    Yeah I would have just figured they would have done it kind of like they did on the back of my arm when it got layed open with a chainsaw. They sewed it shut (after cutting out the dead tissue) but left the stitches far enouph apart that it could still drain as needed.

    Part of it was I was just ticked off that the Dr never realy even looked at it, checked for sensation and mobility or anything else, proved he couldnt even figure out basicmath and had a condesending atitude acting like I was stupid. He stood arms length away and looked at it without it haveing even had the blood that had leaked around the bandage cleaned off.

    Im not to concerned about infection on it. The cut was from a good surgical steel knife that was razor sharp while I was cutting bell peppers and once I cut it I let it bleed for 2-3 minutes under running water before I started to try and slow or stop the bleeding. So it was able to rinse anything out along with the blood and the water got anything else. After I bleed it good I fliped the skin back over the wound and applied pressure with the hand against the same shoulder then went out and hot boxed a couple non filter Camels (nicotine constricts the blood vesels in the extrimities, a trick I learned from an old EMT) and took about 20-30 minutes to get it reasonably stoped/slowed down then abndaged it up with just enouph pressure to be sure it held the flap of skin over the wound and in ablood supply. Its purpleish black tonight about like a REAL bad bruise or a blood blister but can already see where its trying to knitt back to the rest of the skin.

    I figure I will make sure to wait a week or 2 before doing any butchering but the idea of the gloves unfortunatly dont work for me anyhow. While I have never shown any signs of being alergic to latex in other forms ALL of the rubber/plastic gloves I have tried wearing includeing the hypoalergenic, medical, and perferated plastic gloves eat my hands. A lot of them leave visible sores within minutes and open wounds in 2-3 hours and the best of them leave a bad rash within hours. Strange since Drs useing them to examine me, other rubber products and so on never have caused a reaction but for some reason the gloves are just a no go.

    As far as getting it sewed up at this point dont figure will bother with it. It finaly stoped bleeding enouph to be a hassel which was the biggest thing I wanted to put a stop to was haveing it break open everytime the finger twitched in the least and leak even if it didnt. If I was going to mess with sewing it after the Drs visit it most likely would have been just to have gotten into the first aid kit and done it when I got home from the ER. Fact of the matter is that when I first cut it the basic thought was that I was going to have to sew it at home after work untill I remembered I had insurance AND was working at a place with workers comp for a change and could actualy get it done where they could give me local pain killers. When I got cut by the chain saw or other times have been wounded at work never had either one. lol
     
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