Important info if you ever cut your hands or fingers....


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Jim March
December 27, 2002, 03:17 AM
One of the best members at Bladeforums we ever had was the late Dr. Walt Welch. Doc Welch was a retired EMT doctor and one hell of a nice guy.

Anyways. If you ever cut your hand or finger(s), you have TWO WEEKS to sort out whether or not there's tendon damage. After that, it can't be fixed surgically.

Ever.

Got that? That was Walt's advice when I cut the back of my thumb real bad.

Stitches per se matter less. In a lot of cases, you can have a cut that "really needs stitches" but by creative bandaging and totally preventing movement in the affected area, you can get away without it. Especially if you use betadine solution and practice good wound cleaning procedures, and check it every 24 hours for signs of infection. If it's a finger or thumb, tape and splint it bent in a direction that keeps the wound closed.

I'm NOT a qualified medic of any sort, but I've done that a couple of times personally :) and I've had a lot of other successful experience with wound care. If it's healing, by around day 4 or so you can test the tendons by resisting pressure without moving the finger or whatever and if it holds, cool.

If not, get thee to a doc, quick.

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Kentucky Rifle
December 27, 2002, 01:01 PM
Be it on a flashlight OR a wound. I miss him. This is a piece of advice I'll remember. Being a knife collector also, I cut myself a lot. (You should have SEEN the damage I did with a little bitty "Chive"!:eek: )
I take the "Four Rules" of gun handling VERY seriously when dealing with firearms. (Maybe I need to make up a few rules regarding sharp blades too!:rolleyes: )

KR

Don Gwinn
December 27, 2002, 04:04 PM
I'm ashamed to say it, but I didn't know Doc Walt had passed on. What happened?

BigG
December 27, 2002, 04:10 PM
My condolences to Dr. Welch's family.

Dr. Walt Welch was also the one who stated, based on his ER practice, that personal defense designer ammo and FMJ had little difference in terminal performance. Not what the ammo mfrs would like us to know... :eek:

Jim March
December 27, 2002, 05:25 PM
It was about...heck, six or eight months ago I think? Heart attack, if I recall. We are lessened by his passing.

tyme
December 27, 2002, 08:28 PM
Further important info:

If at all possible, avoid cutting yourself. :) (spoken as someone who's never wounded himself deeper than a few mm)

Is there any significant effect on scarring from letting a wound heal without stitches?

George Hill
December 27, 2002, 10:51 PM
The Doc is gone?!!!!?


DAMN!:(

Cal4D4
December 28, 2002, 01:58 AM
tyme:

From having 3 boys with the normal amount of wear and tear, yes. Scarring is greatly reduced with stitches. Good doctors make close stitching (and other techniques) on facial cuts (and cosmetic surgery) to reduce scar tissue. Significant wounds left to gape (like a good cleating) will fill in the gap with scar tissue. It all mostly goes away over the years, but the less you start with, the less there is. Healing - if dirt and stuff is removed first - is much quicker also.

Jim March
December 28, 2002, 04:05 AM
Tyme: the scarring depends on the wound, and I'm not qualified to comment on that. My experience has been very positive but I'm willing to tolerate a bit of scarring that doesn't affect function.

It's my personal belief that a lot of docs do stitches on the assumption that the patient won't be able to immobilize the digit or whatever enough to keep it from blowing open.

But that's a big assumption. If you're willing to "get creative" with the bandaging (good medical tape helps, homebrew splints out of bent coathangers or popsickle sticks or whatever can be a factor sometimes :)) and you LET IT HEAL (plus keep it clean and check it every 24 hours, in my personal opinion you can avoid a lot of stitches. But this is NOT qualified medical advice and didn't come from the late Dr. Welch, OK?

It's the opinion of one guy who's had his share of cuts and is largely immune to novacain and other local anaesthetics and therefore hates stitches! (This is an inherited trait, BTW, I'm also immune to poison oak/poison ivy, and have no allergies at all.)

sm
December 28, 2002, 04:16 AM
Jim March:
Good points
(spent some time in OR setting)
Don't like stitches...tip...talk a DR. or Ns out of Steri-strips
transparent,holds,my last use (appendectomy) internal stitches-external steri-strips.
New deal being touted is Dermabond like superglue for skin,supposed to be OTC one of these days...pricey though.
Get friendly with a Ns, sterisrips and lidocaine...

Okiecruffler
December 28, 2002, 10:48 AM
We use alot of Dermabond in the ED. My daddy was a carpenter and always kept a tube of superglue in his tool box. So I've used both on various cuts and scrapes. Both work pretty much the same way. The best results I've seen is if you can use steri strips and then put the dermabond on top.

Sodbuster
December 28, 2002, 12:09 PM
http://www.bladeforums.com/forums/showthread.php?s=&threadid=186448&highlight=doc+welch
The tributes for Doc Welch can be found here. He was a huge presence and is much missed. Passed away in January of 2002.

sm
December 28, 2002, 01:56 PM
Okiecruffler:

I thought the Dermabond first -then - steristrips??
Proxy strips still being used?? Correct me if wrong.

I still use Balsam of Myrrh for most everything , cuts nicks, etc.
I know vets still use it, In ED have they gone with just Betadine?

Okiecruffler
December 28, 2002, 03:07 PM
Directions say use Dermabond then steristrips, but two of the docs I work with have been doing it the other way around. Keeps the strips on longer and seems to approximate the wound better. Proxy strips I haven't seen at all. We use betadine to prep the area and flush the wound with tons of sterile water. I'm not sure what they do in big city ED's.

sm
December 28, 2002, 03:36 PM
Okiecruffler,
Thanks. You know that does make sense-Dermabond on top of steristrips, steri's supposed to come off per se , but I agree would make wound are better protected.

Proxy strips are flesh colored strips like steri's--never understood why we had them, unless a 'contract thing"...you know what I mean. Big City, ha, it all boils down to $ and the lowest bid....of course a blah blah spiel to rationalize the switch ;)

Betadine good, for the heck of it look up Balsam of Myrrh--word is does some interesting things with cancer now a days.

PATH
December 28, 2002, 04:27 PM
OWW!! I am going to make every effort not to slice myself. It happened once and ever since I have been careful in extremis!

Flotsam
December 28, 2002, 07:05 PM
Typically, dermabond should not be used w/ steris. It can be used to seal a wound that has been closed w/ a subcuticular suture, or by itself for small wounds that are not very deep and not in areas of significant tension. Steri-strips and mastisol or benzoin will work well in a similar circumstance.

Dermabond should be applied in several thin coats while the wound is held together. Using steris first prevents the glue from coating the entire wound properly, and may trap bacteria under the tape strips.

I've used it numerous times in the OR, and it generally works pretty well.

Regular superglue will work, but it creates more heat (which may damage tissues) and may break down into toxic by-products (which may also damage tissues).

I generally tell people just to use steri-strips & benzoin - it's cheap, and can be easily removed if there is any sign of infection.

Sam

sm
December 28, 2002, 07:28 PM
So is the Dermabond "working out"? Kinda new when I was in OR, and used as you described. Mastisol used a bunch, some Dr.'s not impressed with Dermabond, just kept to Mastisol,steri's and benzoin. (doesn't it have some balsam of myrrh in it...forget)

Flotsam
December 29, 2002, 04:48 PM
The neurosurg guys & cardiothoracic guys I work with seem to like it. It's often used incorrectly by new residents - they just glop it on. The ED uses it occasionally (works great for little kids - just gotta keep them from playing w/ the wound for a few days). Can't really see it ever replacing sutures, though.

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