I am not a doctor and they will not let me play one on TV. But suturing on the homestead is a skill often required, particularly with livestock and domestic animals, so here's a starter. Info obtained from Wounds and Laceration by Alexander T. Trott, M.D.

RR

Sutures:

Suture selection depends on several factors: the skill of the person doing the suturing, the location of the laceration or wound being closed an d whether the sutures are being placed internally or externally. For sake of this discussion we'll stick to external sutures and non-absorbable threads.

Silk: the old standby used for many years before the advent of synthetic replacements, and still in common though much less so that synthetics, today.

Advantages are: easiest material to tie knots in, excellent handling characteristics, very good knot security (doesn't come untied on its own). Stores very well. 20 year old sealed packets retain a high degree of original strength if properly stored.

Disadvantages: Highest tissue reaction potential of the various materials, increased potential for infection due to wicking properties of the thread. Tensile strength is wide-range.

Nylon: Monofilament thread, unlike silk, which is braided. One of the first replacements for silk.

Advantages: Tissue reaction is only mid-range, tensile strength is greater than silk. Stores well without deterioration.

Disadvantages: High degree of memory (wants to return to original shape). Requires several throws to tie a secure knot. Knot security is half that of silk.

Polypropylene [Prolene]: Another monofilament thread of newer design that nylon. Stores very well long term.

Advantages: Very low tissue reactivity, highest overall tensile strength.

Disadvantages: Very low knot security, high degree of memory.

Dacron [Mersilene]: Another synthetic with a high favorability. Good storage potential. May be more affected by high heat storage conditions than others. Excellent replacement for silk.

Advantages: Easy to handle with very good knotting characters. Knot security approximately equal to that of silk. Less risk of tissue inflammation than with silk.

Disadvantages: Tissue reaction potential higher than other synthetics. Tensile strength half that of nylon.

As far as selection of suture for size and needle:

Needles: two types commonly found on pre-attached threads, (reverse) cutting and (round) tapered. The cutting needle is easier to work with. The reverse taper means the back (inside) edge is flattened to ensure the needle puncture wound is not inadvertently enlarged. The cutting needle is also thought to be less traumatic to the tissue as it passes through.

Needle grades: cuticular and plastic.

Cuticular: Less expensive but noticeably less sharp. Generally coded as either C (cuticular) or FS (for skin) on the box or packet.

Plastic: refers to plastic surgery grade needles. Sharper, less traumatic. Coding usually starts with the letter F.

Size:

Sutures are sized like shotguns. The higher the number the smaller the diameter of the thread. Sizes range commonly from 0 to 6-0, with negative numbers and higher numbers going up to 10 in the case of eye sutures. For our purposes 2-0 to 5-0 will fill the bill. 2-0 for very high stress areas and then it depends on activity level, precise location and whether scarring matters or not.

For plastic surgery such as around faces 6-0 is preferred for the lesser chance of scarring. Plastic surgery technique also involves a lot of shorter close sutures as opposed to simple wound closer where scarring is not a concern per se. It is time consuming and an acquired skill.

5-0 is the most commonly used size for most purposes. It had good tensile strength vs. diameter and does not have quite the scarring potential of larger diameters.

4-0 is a good substitute for 5-0. It is also recommended for areas of greater stress. A large laceration on the biceps for instance when the patient regularly engages in heavy lifting, etc.

3-0 should be considered for a knee or ankle joint. Greater tensile strength and the larger diameter make it less likely to pull through the tissue and rip out. Much more likely to leave the characteristic "railroad tracks" that mark old sutures.

2-0 The largest practical diameter for our uses. Heavy use areas. Possibly a better choice in the absence of 3-0 than 4-0 would be. Determine on case by case basis.

-- Reasonable Rascal (ayrman@pcsia.net), December 08, 2001

Answers

butterfly or super glue

-- stan (sopal@net-port.com), December 08, 2001.

When the emergency is there, I would grab for whichever is closer: butterfly or super glue. If I had time, I prefer superglue for low- tension situations, such as flaps of skin. I prefer butterflys (I don't think the plural in this case is butterflies) when there is high tension - that is, the two sides of the incision naturally are spread apart. The butterfly works well for bringing them together.

There is no reason not to make use of both - again, if both are readily available.

-- Audie (paxtours@alaska.net), December 08, 2001.

As written by a practicing physician for another forum:

1. Superglue is not cyanide based. Cyanoacrylate is not cyanide.

2. Wound glues, Durabond & similar, are not used in the wounds but rather over the wound after the edges are approximated.

3. They are for use on small low tension wounds, minor cuts & etc., use for major wound closure is generally avoided except some special closure problems.

4. It has not replaced stitches for a variety of reasons.

5. It is very expensive if you use the medical grade stuff.

6. It (and all cyanoacrylate glues) is easily removed by acetone (finger nail polish remover) you do not need to leave someone stuck together for 4 weeks.

7. It is neither absorbed or extruded by the body, it sits inert on the surface until it weakens and peels off.

I use the medical glue on a weekly basis in the ER, and over the counter stuff has been known to be used in the field on many occasions. -------------------------------------------- Regarding butterflys, or suture strips (same concept) there are limitations. Taken again from Wounds and Lacerations.

- They are limited to superficial straight lacerations under little tension. Suitable areas include the forehead, chin, thorax (chest, sides and back) and non-joint areas of extremities.

- Lacerations with a greater than usual chance of infection

- Support for lacerations after sutures are removed.

They do NOT work well for:

- oily or hair bearing surfaces

- joints

- lax skin

- areas that are under more than moderate tension

-- Reasonable Rascal (ayrman@pcsia.net), December 08, 2001.

Did emergency surgery on my chicken that was dying the other day. I used a lovely shade of red sewing thread and used a "sharp"(sewing talk for regular needle). Heehee! The hen is still alive and well. I was able to save her. I have also stitched up turkeys, and geese. The red thread is optional! :~)! Helped a friend stitch a horse once. We used a hair out of his tail. Worked great!

-- Nan (davidl41@ipa.net), December 09, 2001.

I've used lots of different materials in emergency situations, the first being on the ranch in Montana when I was 15 years old with one of my horses with a nasty tearing/puncture wound. Couldn't get her to the vet and the vet told me where to put the stitches when I described the wound. Used a curved upholstery needle and some of dad's fishline ... worked just fine.

Currently I keep a couple of sterile surgical suture kits on hand, always keep one with me in my "travel box" and also keep superglue and bandages on hand as well, as well as adhesive tape to make emergency butterflies. I also have both spray on and injectable lidocaine ... and a tranquilizer as well ... saves a lot of wear and tear if you have to actually scrub wounds out and/or stitch.

-- SFM in KY (timberln@hyperaction.net), December 09, 2001.

Does anyone know what the typical shelf-life is for sterile absorbable suture kits? In my kit I have some 3-0 absorbable (Dexon braided polyglycolic acid) that comes in the little packs with curved taper needle. Any idea how long this kind stays usable when kept under ideal conditions?

-- Dave (something@somewhere.com), December 09, 2001.

SFM, good idea on the suture kit! I bet you could get one from the vet or a vet supply co on the internet. The doctor I worked with was partial to 5-0 Prolene.

-- buffy (buffyannjones@hotmail.com), December 09, 2001.

Rascal - thanks for the patch from the physician's response. I want to clarify I was referring to true *emergency* situations. I don't have the luxury of debating whether to have a doctor/vet/faith healer patch something up: for me it's 3 hours to the nearest clinic and 5 1/2 to the nearest hospital.

-- Audie (paxtours@alaska.net), December 09, 2001.

Audie, you may want to consider acquiring a skin stapler or two in that case. Very fast, easy to use, and if you are tough you don't need a local for a few shots. 20 seconds vs. 20 minutes of work. Just a thought for when tapes and/or glue won't work.

RR

-- Reasonable Rascal (ayrman@pcsia.net), December 09, 2001.

Oooff. I do know folks who have just gone to their workbench and gotten out the staple gun, though...

-- Audie (paxtours@alaska.net), December 09, 2001.

If you had the HMO we had a few years back, this knowledge would be very useful :>)

-- Jay Blair in N. AL (jayblair678@yahoo.com), December 10, 2001.

Audie that sounds very PAINFUL!!!!!! YIKES! Hold still dear this will only hurt for a few minutes. heehee!

-- Nan (davidl41@ipa.net), December 11, 2001.

I am glad to hear I am not the only one who uses super glue ! I have done some great work with it .I used it on a dog and cannot even find a scare .I always keep it around for emergencys.

-- Patty {NY State} (fodfarms@hotmail.com), December 11, 2001.