I really have to say this because it is bothering me. A lot of well meaning preppers ask me about sutures, or have sutures in their kit.
DO NOT suture anything unless you REALLY know what you're doing. It isn't as simple as just sewing the ends together. You need to be trained in properly debriding wounds (including cutting out dead muscle tissue, etc). Not to mention, you also have to know the different layers of tissue to be sutured. You risk killing the person by sealing in all infectious material and debris.
So you are probably thinking, "this wound will never heal without stitches" right? That isn't true. A lot of suturing is for cosmetic reasons (to reduce scarring) and to obviously keep the flesh together for functionality and quicker healing. Even very deep wounds can heal without sutures, but they will taking much much longer and probably have very ugly scarring. On the other hand, you will not be "sealing in" unwanted debris and you will be allowing the wound to drain properly.
So please, do not suture or attempt suturing if the SHTF because "you have to." You don't, and the risk it too great.
Continue reading if you care to learn what to do without sutures
So now that you know that sutures aren't completely necessary, you are probably wondering what you're supposed to do. It took me a while to realize this, but after talking to a physician who is into this SHTF stuff I finally have it down.
For one thing the wound must be irrigated (with copious amounts of sterile or clean water if sterile isn't available). At the end of the irrigation process, something to get the pressure of the irrigation up would be beneficial as well. By this I mean if you have access to IV equipment, then use a 20gauge catheter, that way you can "pressure wash" the wound. After the irrigation, one thing we are missing out on is wound debriding (cutting away the dead skin around the holes, and the dead muscle inside). I don't know how to do this properly, and I assume you don't either. I will just leave it at that.
If you wound really isn't that bad, but its one of those that someone would say "oh you need stitches to close that up" then you probably can get away with irrigating it and keeping it clean every day. It should heal on its own in time.
As for the deeper wounds, its a bit different. Now after you have your wound irrigated with a shitload of fluid (which is proper medical terminology for "several liters" in case you didn't know), you will pack it with sterile (or aseptic/clean if its all you have) kerlix (stretch gauze rolls) or gauze. This will allow it to drain by keeping it open. You must change these atleast 2 times a day bare minimum and irrigate before putting in new packing.
Now you ask "well with all of that junk in there how will the wound ever close?" Don't worry, this boggled my mind at first too. Eventually you should be able to pack less and less in the wound, over time of course. It will heal from the bottom up, so to speak. One thing you have to watch out for is premature closing of the top layers of tissue. The healing from the bottom up MUST happen this way, and if the top layers were to close prematurely, you will be setting up for an anaerobic infection that will probably result in death in SHTF conditons. So, now you can see why just suturing the top flaps of skin together in a deep wound could be lethal. It's the same concept. What about the dead muscle tissue that needs to be cut out? I honestly don't have an answer for you on that yet, because I simply don't know how to do it.
To qoute the physician who has helped me on these topics:
Things to watch out for would be early closure of the skin before the underlying tissue was free of infection - that would cause an anerobic infection which would probably be fatal, absent an amputation (think Gangrene).
I will also mention that there are some wounds in which the layer of skin of completely gone. This is qouted from a zombiehunters.org discussion
"...just sharp and jagged enough to shave all the skin and flesh off of your left shin. Right down to the bone. The meat that was formerly known as your shin (now known by the symbol ) is now dangling from the rock, completely detached from your leg, looking like a flesh colored and slightly bloody chamois cloth.
Talk about SHAM-WOW!
The idea is that it will heal inwards like any other wound. You must irrigate regularly, but not forcefully enough to disrupt the new growing skin cells. Keep it covered. Healing will take a long time for this one. What you don't want to do is try to pull the skin tight together and suture it, or try to reattach the dead skin.
Now that we're taking care of this wound and the SHTF, we are on our own. Many people are really into antibiotics in this community, but I must caution you on one thing: learn about them. Each antibiotic is make for a specific duty, and you can't just give any old antibiotic and expect results. What was recommended to me for a severe wound like this (it was actually a GSW to the leg...which was mutilated) was hopefully something that is a broad spectrum antibiotic, like moxifloxacin (Avelox). Failing that, he recommends Azithromycin (ZPack) and Septra DS (Trimethoprim/Sulfamethoxazole Double strength) also known as Bactrim. He emphasizes that antibiotics really depend on many things, such as the suspected type of organism and what is usual in your area. Due the complications of understanding antibiotics, I will not go on about the treatment of them. You must learn about these on your own. One thing I will say is keep your expired pills. They are most likely good long after the expiration date.
Some people mention honey or sugar for fighting infections, and it really is a legitimate treatment for local infections. I believe the proper treatment with sugar is to pack the infected wound with granulated sugar mixed with Betadine to form a thick paste. Sugardyne was a commercial product of this that no longer exists (unless they started making it again). The concoction. must be washed out numerous times a day, irrigated, and reapplied again. It will also be drawing moisture from the patient, so hydration is important. There are other ways to do this, do the research yourself.
As far as healing goes, it depends on the wound and if it gets infected or not. For really nasty ones it could be up to 2-3 months.
Now imagine changing dressings multiples times a day for that long of a time period. You better reevaluate your gauze and kerlix supply.A lot would depend on avoiding infection (strict hygiene, frequent dressing changes) and the patients nutritional status (especially zinc, copper, protein, and vitamin C).
Other complications need to be thought about. What if the injury was a GSW which shattered a bone in the extremity? There may be nothing you can do to save this person. Depending on the injury, the bone may lose blood supply and cause necrosis of the leg. Ready to pull out the hacksaw and amputate? You are likely to kill them. It is much more complicated then just hacking off a limb. What to do? I don't know...you better hope there is some way to get to a hospital.
So I hope you thought this was worth reading and have learned a thing or two. Just remember that some things you just can't fix and we will have to hope that a medical infrastructures still exist post-SHTF for certain things.