The best suture material I have found that anyone can purchase online is the brand Unify, available through Amazon and elsewhere. For suturing of skin wounds, the 3-0 and 4-0 Nylon are most useful to have on hand, though having some 5-0 available for lacerations of tender skin (face/children/fingers) is a good idea.
For my own patients, I use professional suture, which does cost more, but is more difficult for the layman to procure. (Check back soon – I may begin offering this for sale on my own site.)
The only problems I have had with the Unify suture, which I use for my live Survival Medicine classes, is that the needles may bend a little easier and the suture may detach from the needle a little easier than higher grade suture. Still, I believe they are adequate for most wound closure and anyone can get them.
For additional articles on suturing, see Essential Medical Skills to Acquire: Introduction and Doc Cindy on SurvivalBlog.
As an old home health wound care nurse with years of “delayed closure” wounds experience, I very much appreciated this post, and wanted to affirm pa4ortho’s advice to avoid suturing a wound in TEOTWAWKI. Allowing a wound to close slowly by secondary intention gives the ability to continually assess for infection, carefully debride if necessary, and evaluate the healing process. Yeah, the scar might not be as pretty, but far better than having to perform and I &D for an abcess, and then worry about how to treat the infection. Raw honey is a readily available resource with antibacterial and anti inflammatory properties, and also promotes new tissue regrowth. I have stockpiled a large amount of this precious resource for medical and culinary purposes! Cheers!
Thank you for posting this! Just discovered your website today. Will definitely be looking through it more thoroughly some other time as it seems to be an excellent survival medicine resource. Thanks again!
In an austere setting with basic skill sets, what are you planning to suture with dissolving suture? My list is short,
1. finger nail, but nylon removed promptly works
2. dental, but nylon removed promptly works
3. I’m not likely to sew much in the intestine but again if I need to tie off an appy, nylon works fine,
4. Deep wounds in an austere setting I will close in layers using retention sutures if needed. I prefer delayed secondary closure of most wounds in an abo scarce environment. Again all can be done with nylon.
5. tendon repairs can be done with nylon
6. vessel ligation, nylon
I personally don’t carry much in my kit other than 3-0 and 4-0 nylon. In a small portable kit: 5-0 for eyelids but again 4-0 works in a pinch, and some real big stuff with a red rubber foley for retention sutures in the big kit.
Again I can’t say it enough: most wounds should not be closed in austere settings primarily.
Improvising to hurry up and close a wound before you get to the ER…. does not make sense. Cover it, direct pressure if needed. TQ if needed.
In a grid down setting, irrigate a lot. Then irrigate some more. Pack with moist gauze/autoclaved bed sheet or t-shirt. Delayed closure reduces infections, saves lives.
or…… – if you want toss the multi pliers in the soup and boil them up with the suture and you can use them as needle drivers if you prefer.
6 pound nylon fishing line
18 gauge needle
multi pliers tool
grip the pointy end of the needle with pliers carefully
cut the plastic hub off the base with a knife, scrape any residual white cement off with a knife, insert the fish line in the base of the hollow needle and crimp it in place by crushing the base of the needle with the pliers onto the nylon suture.
use the pliers to bend the end of the needle into an arc the diameter roughly equal to the distance you need to span with the suture. it should then look like a J with the suture coming out of the top of the J
toss the suture and needle in boiling water
allow the water to cool while covered
use the water to irrigate the wound well, sew only if indicated in austere settings. remember many wounds don’t need sewing
you can hold the J shape needle in your hands and push against a small boiled stick or q-tip when sewing, because of the long “handle” on the J shaped needle you don’t need a needle driver.
great study showed no difference in infection in traumatic lacerations with sterile gloves, clean gloves and well washed hands
no difference in infection rates when irrigating with tap water vs sterile water
hope it helps
great post. do you know of biodegradable suture line for internal sutures?
[Doc Cindy replies: good options are chromic, polyglycolic, and polydioxanone.]
improvised suturing with a sewing needle.
Due to the drag of the folded suture at the eye of the needle this is not going to do dainty tiny repairs. Think big heavy retention suture placement or rough wound closure in lacerations. This will not do tendon repairs or eylid repairs well.
you can use it as a hand held keith needle and just sew away. however there are advantages to using a curved needle in everting the wound and getting deeper closure minimizing dead space in the wound where blood can form a large hematoma and slow healing or increase infection risk.
To form a curved needle, heat it to red hot first to destroy the temper so it wont just snap but will bend. Then bend it with pliers into a gentle curve a little at a time moving the pliers around to get a smooth arc.
then insert fishing line to sew in place. use a sewing needle loader to thred the suture easily. I like to use small 10″ sections of suture and hand tie when doing this
Thanks for the great info! I just added the suture kit and some additional supplies to my Amazon wishlist. I will get there eventually! 🙂
Several times Ive had to use just plain ole fishing line , Out in the field … The first time a fellow that wasnt a part of our group, was out playing with his machete. The clown was wearing plain ole sneakers hacking down some maiden cane. Well yep as you might have guess he hacked right thru his shoe, An put a large gash into his left foot…. we sew’ed him till they could drive him to a hospital….
An the second time , a group of hunters camped down the road from us were out hog hunting , an one of the lead dogs got hooked up by a big ole boar. That poor ole pup was ripped from his chest to about middle his belly….. I rinsed the wound out with some water , pushed his inners back in him , an sew’ed him up with some 10 pd test fishing line till they got him to the vet. Oh he was out running the next yr. the owner called to let me know an thanked me …