EMERGENCY SURVIVAL GUIDE: HOW TO SUTURE

Whether you are a survival enthusiast learning emergency first aid, or a young surgeon in the making, knowing how to suture is an invaluable skill. Enclosed is a step-by-step guide on how to use a surgical suture to close a wound or deep cut within the skin. This set of instructions will first go through how to cleanse the wound and sterilize the necessary instruments: a surgical suture (a specialized medical strand of fiber connected to a hooked needle), forceps (a handheld, hinged tool to grasp objects), and scissors. The next steps will explain the process of sewing up the wound using the surgical suture to make square knots (a symmetrical double knot) across the wound to close the gap and allow the wound to heal. The process is easy and can be completed in a matter of minutes. Though, the total time taken can vary based on the number of sutures needed to completely seal the wound and dexterous you are. Ultimately, the goal of this guide is to teach you how to close a wound as efficiently and quickly as possible in emergency situations when a paramedic or doctor is not present.

WARNING: Nonprofessional surgical suturing should be done in emergency situations only. Always consult a paramedic or doctor after suffering any serious injury. Surgical suturing should be completed by other people when possible, but can be done on your own if necessary.

MATERIALS
Medical (First Aid Kit) Nitrile Gloves (Fig. 1) Hydrogen Peroxide (Fig. 2) Gauze Pads Surgical Suture (Fig. 3) Forceps (Fig. 4) *Household Alternative **Wilderness Alternative Rubber Dishwashing Work Gloves Gloves Rubbing Alcohol Fresh Water Cotton Balls Needle and String, e.g. Sewing Kit Tweezers N/A Twig and Plant Thread N/A Pocket Knife

Stainless Steel Scissors Kitchen Scissors (Fig. 5)

*If a first aid kit is not available at home, there are alternative materials that can be found in the household **If a first aid kid is not available in the wilderness, there are some alternative materials that can be used or gathered depending on what is available

Fig. 3: Surgical Suture Fig. 1: Nitrile Gloves Fig. 2: Hydrogen Peroxide

Fig. 4: Forceps

Fig. 5: Stainless Steel Scissors

STEP-BY-STEP
SANITIZATION AND CLEANING
*IT IS IMPORTANT TO COMPLETE THE SUTURING A CLEAN ENVIRONMENT AND
ENSURE THAT THE WOUND IS NOT CONTAMINATED IN THE PROCESS

STEP 1 Put on a pair of nitrile gloves as a form of proper protective equipment STEP 2 Sanitize the surgical suture, forceps, and scissors by rinsing them with hydrogen peroxide, and wipe them dry using a gauze pad Note: If the materials are obtained from a first aid kit, they will most likely already be sterilized. Nevertheless, it is good practice to sanitize instruments before any kind of medical procedure. STEP 3 Rinse the wound with hydrogen peroxide, and then dab the wound dry using a gauze pad, while applying slight pressure. Note: Only pour a small amount of hydrogen peroxide onto the wound. Any large amount poured will increase the level of pain and discomfort as the hydrogen peroxide cleans the wound. You know the hydrogen peroxide is cleaning when bubbles fizz on the wound.

SUTURING
*FOR PRACTICE SUTURING, USE A FRUIT OR PIECE OF CARDBOARD WITH AN OPENING OR GAP MADE , THAT CAN BE CLOSED UP BY THE SURGICAL SUTURE STEP 4 Use the forceps to lift the skin of one side of the wound, and using the remaining hand holding the surgical suture, puncture the skin with the needle end of the suture. STEP 5 Repeat Step 4 lifting the other side of the wound, by puncturing the skin with the suture. The result should look like the figure right. Thread the string through the two holes created using the suture.
Fig. 7: Entry of the suture into the skin on both sides of the wound Fig. 6: Raising the skin the wound

*NOTE: FIGURES ILLUSTRATED BELOW DEPICT THE USE OF COLORED STRING TO

ALLOW THE READER TO UNDERSTAND MORE CLEARLY

STEP 6 Orient the string so that string closest to you is longer, and shorter on the other side. *Blue is the short end. Red is the long end.

Fig. 8: Orientation of the sides of the suture: longer on the side closest to you, shorter on the opposite side

STEP 7 Using your dominant hand, position the forceps in a center position above the gap and nearly perpendicular to the string, just as in Fig. 9 STEP 8
Fig. 9: Orientation of the forceps

Using your nondominant hand, wrap the long end of the string around the tip of the forceps once, going away from your body

Fig. 10: Wrapping the long end around halfway

Fig. 11: Wrapping the long end around to face towards you

STEP 9 Wrap the long end of the string around the forceps again leaving the end of the string pointed toward your body

Fig. 12: Wrapping the long end around halfway again

Fig. 13: Wrapping the long end around to face towards you again

STEP 10 With the tip of the forceps still free, open the forceps, and clamp the short end of the string

Fig. 14: Opening and moving the forceps towards the short end of the string

Fig. 15: Clamping the short end of the string

STEP 11 Pull your left and right hands in a straight line away from each other, perpendicular to the wound to ensure a flat knot.

Fig. 16: Pulling your left and right hands away from each other

Fig. 17: Pulling in a line perpendicular to the wound, making a flat knot

STEP 12 Unclamp the forceps to release the short end of the string, and reposition the forceps above the knot in the center, just as in Step 7. *Note: The knot should be nearly linear and flat STEP 12 Using your nondominant hand, wrap the long end of the string around the forceps towards your body once

Fig. 18: Orienting the forceps again

STEP 13

Fig. 19: Wrapping the long end around once to face towards you

Open the forceps to clamp the short end of the string

Fig. 20: Opening and moving the forceps towards the short end of the string again

Fig. 21: Clamping the short end of the string again

STEP 14 Pull your left and right hands in a straight line away from each other, perpendicular to the wound to ensure a flat knot, just as in Step 8

Fig. 22: Pulling your left and right hands away from each other

Fig. 23: Pulling in a line perpendicular to the wound, making a flat knot, completing the square knot

STEP 15 Unclamp the short end of the string. *Note: The knot, now called a square knot should be nearly linear and flat, like the figure to the right. STEP 16
Fig. 24: Completion of the square knot

Cut the ends of the strings using scissors. Leave enough length for the ends to be clamped by the forceps in case the knot needs to be untied.

TROUBLESHOOTING AND TIPS

Repeat the Steps 4-16 as needed to seal the entire gap of a wound, by making knots across the line made by the gap of the wound, like the figure to the right If any errors occur during the process, it is best to untie the knot and start from the beginning When the knot is bulky, it is called a Granny Knot, and can be avoided by ensuring the ends of the string are pulled correctly. A Granny Knot does not prevent the wound from being sealed, however the goal is to make small, clean square knots.
Fig. 25: Line of sutures made to seal the wound

REFERENCES
Fig. 1: http://cdn.shopmedvet.com/images/large/NITRILE-XL.jpg Fig. 2: http://www.passionatehomemaking.com/wpontent/uploads/2009/04/fam_hydrogen_peroxid e_pint-4080.jpg Fig. 3: http://upload.wikimedia.org/wikipedia/commons/e/e9/Atraumatisches_Nahtmaterial_17.JPG Fig. 4: http://www.wagner-medical.com/images/needle-driver-large.jpg Fig. 5: http://nycprc.org/images/Threaded/SutureScissors.jpg Fig. 6: http://i1.ytimg.com/vi/iYts9c6Jrx8/hqdefault.jpg Fig. 7: http://apps.med.buffalo.edu/procedures/repairoflacerations_files/image003.jpg Fig. 8-23: www.anzjsurg.com/view/0/suturingKnotTying.html Fig. 24: http://upload.wikimedia.org/wikipedia/commons/a/a0/Square_knot.svg Fig. 25: http://www.iacuc.msu.edu/training/Shared_Images/suture_continuous_lock.gif