I have an alleged week off, and I always say ‘alleged’, because no matter how much I try to over work the week before and set aside catch-up time for the week after, there’s always stuff that comes up. It’s just the nature of the job. But I’m also blessed with a herd of patience to care for that. Never really abuse. The privilege of access to me 24/7.
However, I thought I had caught up with everything last night, so since gun season is just kicking in here and I wanted to catch up on sleep Saturday before hunting Sunday, I didn’t wake up until 5:30 AM which is later than on a workday, and all I did was go downstairs, Throw a dry log in the furnace and on the way back upstairs stopped in the kitchen for two quick shots of Jack Daniels and a doughnut (not exactly the breakfast of champions, but I figured I didn’t need to have that kind of breakfast since my mission was to go back upstairs and sleep till noon, which I did…!).
Normally, the Granddaughter, who is almost 3 years old, comes over from next-door, too, wake us up on our days off, shortly afternoon, which is what happened. However, instead of being cheerful, she was clearly distressed, and I found out from her mother that it was tears of empathy for one of our Great Pyrenees, who had been injured overnight…
With just an initial assessment, thankfully there is no penetration into the body cavity, or even any exposed muscles, and the wound was quite clean. The skin had peeled way back so the actual wound was approximately 6” x 10”, with the worst up underneath where my hand is in the photo above. I say worst mostly because that was just the hardest area to get the tissue figured out as to alignment because let’s just say there is a lot of ‘redundancy’ on a large dog’s skin.
(…like I should talk… 
)Thankfully, I’ve learned how to do what’s needed for that, and we had a box full of 3-0 absorbable suture, a combination needle holder/scissors, and a regular scissor to trim away the fur. We also had a bunch of lidocaine with epinephrine in it and 3cc syringes with inch long 23 gauge needles for numbing.
I mention all that because those are things that you guys should all get and keep on hand. I think the only thing requiring a prescription would be the lidocaine with epinephrine. Farm stores might sell that, but I’m not sure. You could probably talk a physician into prescribing some for you. It’s perfectly legal as long as you have a Dr patient relationship with that physician.
Thankfully, the dog was pretty relaxed, and I didn’t even have to inject the lidocaine because of the nature of the wound. I just squirted it on and let it take affect. Ideally, you should wait a couple minutes for that.
We looked around, and found the offending object. There’s almost no way to eliminate all of those without taking portable generator and an electric an angle grinder around all of the gardens and pasture areas.
It’s hard to describe but easy to do, to use a needle holder and stitch. I’m sure there are plenty of Internet videos on that. But it’s a good skill to have, and certain light a small kit with the necessary stuff in it in this case, saved an emergency trip to a veterinary clinic, and probably a good bit of money. Although I’m sure “…it’s not recommended to perform advanced first aid or wound care on a human without proper training, certification, licensing, malpractice insurance, and making the Patient sign a 23 page contract that you have notarized…”, most of us at some point or another may have an occasion where we choose to do so, or have no other choice, but to do so. Anything more than skin deep can get pretty spooky, and doing layered closures (where the stitches on the underneath layer are buried because you are closing another layer on top of that) is something that I don’t even like to do in the office under controlled circumstances when taking off skin cancer or something, much less trying to repairsome sort of traumatic wound.
However, if you’re on an extended hunt or backpacking outing where you couldn’t even get to first aid without a helicopter ride, packing such a suture kit would be a good idea. Get enough suture that you’ve got some spares to practice with so you can get good at knot tying, and get fancy and practice some of the various types of stitches for wound closure. Generally separate individual stitches, where you cut the suture each time our ideal because if one breaks, the wound doesn’t completely open, although there are occasions where you might use a running closure where you sort of halfway lock the stitches by going under the previous one. Mostly you would do that for a very quick closure in the field, maybe with the intent of stabilizing things otherwise and then going back and redoing the stitching in a more controlled setting an hour or so later.
In the office, I mostly use size 5-0 and 6-0 suture, because I want to minimize scarring. I use proline which is not observable because the observable stuff tends to irritate the skin, plus I like to recheck the wound in 10 days anyway when I remove the sutures. Proline is bright blue so it’s easy to see if it’s a body area that has much hair.
However, for first aid purposes or veterinary purposes, I don’t wanna be worried about counting sutures and removing them later, and I’m generally not too concerned with scarring so I’m going to use 3–0 suture mostly. Certainly on an animal. On a person I would probably use 4–0 sometimes (for field first aid, not elective procedure…!)
There are various brands of absorb the suture, and honestly, I can’t tell much difference between them so I usually get whatever the least expensive. I really never had to use large absorbable suture on a human because the wounds I stitched up on myself and family I’ve been relatively minor. So far I’ve used some observable suture that is a couple years past its expiration date without any problems. As far as lifocaine with epinephrine, I view some on myself that was eight or nine years past its expiration date without a problem. I’ve had a couple patients who had skin cancers needing removed, where they were anaphylactic with lidocaine, and you can often get decent anesthesia by just injecting, sterile water, since the fact that it is not sailing messes up the local electrolyte flow enough that the nerves don’t work well.
I guess it’s worth noting that the epinephrine is added to help slow bleeding, which makes it easier to see what you’re doing, and helps the lidocaine stay in place and keep the tissue numb longer, but note that use of lidocaine with epinephrine in it should supposedly never be done on fingers or toes or earlobes or the nose or the male erectile organ, and which places we are told we should only use plain lidocaine. However, I remember specifically during residency seeing a hand surgeon, orthopedic surgeon, ear, nose, and throat, surgeon, and urologist, all break that rule, for what that’s worth.
