Basic Suturing

The goals of wound closure include obliteration of dead space, even distribution of tension along deep suture lines, maintenance of tensile strength across the wound until tissue tensile strength is adequate, and approximation and eversion of the epithelial portion of the closure. Methods for mechanical wound closure include staples, tape, adhesive, and sutures. Each method has specific indications, advantages and disadvantages, and special considerations.The subject of this article is the suture closure of wounds. Similar to other methods of wound closure, suture closure permits primary wound healing. Tissues are held in proximity until enough healing occurs to withstand stress without mechanical support. An extensive review of wound healing and the factors that influence this process are available elsewhere (eg, see the eMedicine articles Incision Placement; Wound Healing, Nerve; and Wound Healing, Skin).
Suture material is a foreign body implanted into human tissues; it elicits a foreign body tissue reaction. During wound closure, a sterile field and meticulous aseptic technique are critical to minimize the risk of wound infection. Other complications of wound healing, such as hypertrophic scars, wide scars, and wound dehiscence, may result from patient factors (eg, nutritional status), incorrect suture selection, or a technique that results in excessive tension across the wound.
Skillful wound closure requires not only knowledge of proper surgical techniques but also knowledge of the physical characteristics and properties of the suture and needle. The goal of this article is to review the types of sutures and needles for wound closure and to discuss principles that influence suture and needle selection.
For excellent patient education resources, visit eMedicine's Procedures Center. Also, see eMedicine's patient education article Suture Care.

Suture Qualities

Ideal suture characteristics

The ideal suture has the following characteristics:

• Sterile
• All-purpose (composed of material that can be used in any surgical procedure)
• Causes minimal tissue injury or tissue reaction (ie, nonelectrolytic, noncapillary, nonallergenic, noncarcinogenic)
• Easy to handle
• Holds securely when knotted (ie, no fraying or cutting)
• High tensile strength
• Favorable absorption profile
• Resistant to infection

Unfortunately, at present, no single material can provide all of these characteristics. In different situations and with differences in tissue composition throughout the body, the requirements for adequate wound closure require different suture characteristics.

Essential suture characteristics

All sutures should be manufactured to assure several fundamental characteristics, as follows:

• Sterility
• Uniform diameter and size
• Pliability for ease of handling and knot security
• Uniform tensile strength by suture type and size
• Freedom from irritants or impurities that would elicit tissue reaction

Other suture characteristics

The following terms describe various characteristics related to suture material:

• Absorbable - Progressive loss of mass and/or volume of suture material; does not correlate with initial tensile strength
• Breaking strength - Limit of tensile strength at which suture failure occurs
• Capillarity - Extent to which absorbed fluid is transferred along the suture
• Elasticity - Measure of the ability of the material to regain its original form and length after deformation
• Fluid absorption - Ability to take up fluid after immersion
• Knot-pull tensile strength - Breaking strength of knotted suture material (10-40% weaker after deformation by knot placement)
• Knot strength - Amount of force necessary to cause a knot to slip (related to the coefficient of static friction and plasticity of a given material)
• Memory - Inherent capability of suture to return to or maintain its original gross shape (related to elasticity, plasticity, and diameter)
• Nonabsorbable - Surgical suture material that is relatively unaffected by the biological activities of the body tissues and is therefore permanent unless removed
• Plasticity - Measure of the ability to deform without breaking and to maintain a new form after relief of the deforming force
• Pliability - Ease of handling of suture material; ability to adjust knot tension and to secure knots (related to suture material, filament type, and diameter)
• Straight-pull tensile strength - Linear breaking strength of suture material
• Suture pullout value - The application of force to a loop of suture located where tissue failure occurs, which measures the strength of a particular tissue; variable depending on anatomic site and histologic composition (fat, 0.2 kg; muscle, 1.27 kg; skin, 1.82 kg; fascia, 3.77 kg)
• Tensile strength - Measure of a material or tissue's ability to resist deformation and breakage
• Wound breaking strength - Limit of tensile strength of a healing wound at which separation of the wound edges occurs

Suture size

The United States Pharmacopeia classification system was established in 1937 for standardization and comparison of suture materials, corresponding to metric measures. The 3 classes of sutures are collagen, synthetic absorbable, and nonabsorbable. Size refers to the diameter of the suture strand and is denoted as zeroes. The more zeroes characterizing a suture size, the smaller the resultant strand diameter (eg, 4-0 or 0000 is larger than 5-0 or 00000). The smaller the suture, the less tensile strength of the strand.

Are you already a "Survivalist"?

TEOTWAWKI: You Don't Need to be a Survivalist to Know What it Means; that Alone Should Worry You

Are you a survivalist or do you consider yourself to be prepared? If you do then you know what TEOTWAWKI stands for right? It means The End Of The World As We Know It, that’s why people just kind of make it shorter, it takes up too much room any other way you say. The fact that people know what it means or for that matter are even thinking like that should be sending warnings off in your head. Its pretty sad when people are planning on a major meltdown and even making up words for it.
Is it the whole 2012 deal? Is it a giant comet hitting the earth? How about the new craze which is a zombie attack? Maybe its a video game? The truth is no, its not any of those things. The sad part it that its based on what more and more people are seeing happen around the nation and the world. Most responsible people are saving more, buying a few extra food items when they go shopping. Not buying things they don’t need. All pretty normal stuff when things get tight. But how do you explain the huge increase in gun and ammo sales? I know, its all Obama right? Nope, its more than that. People are concerned over a variety of events they see happening. Things like an economic collapse are right at the top. Terrorism is up there as well. A civil breakdown in whatever form you can foresee, the scenarios go on for awhile. But the key here is that people, normal everyday people have lost faith in the things that they normally took for granted. Normal people see trouble on the horizon and are trying to get prepared for it. By the way, the safe picture above, is probably a little more prepared than most so don’t worry, I’m just trying to figure out how they got in my bomb shelter to get the picture.
Another sign that should worry people is that mothers are getting concerned more and more everyday. Polls showing people believe their lives are better than what their children will have is a sure sign of problems. People believing the country is going in the wrong direction by almost two to one is another one. When mothers start worrying about their children, its reached critical mass. These people don’t believe in giant asteroids hitting the earth, they believe the country and the world is sliding out of control. TEOTWAWKI to them is the loss of faith in the government, faith in society to do whats right. They see a government grabbing power, an economy not going anywhere, unemployment still going up and no jobs in sight. They see their savings dwindling down to nothing, they see bills building up. They see banks getting money but normal people loosing their homes and cars. They see rogue nations testing and developing nuclear weapons knowing these countries hate America. There is for sure a lot to be worried about other than zombies or comets or how about this one, global warming.
So if you are storing away things are you a survivalist now? Does being prepared or at least trying to, make you “one of those people”? I don’t think so. And it looks like the survivalist stores, camping stores, preparedness web sites, gun stores, even bulk food sales store don’t think so either. Don’t believe them, ask gold dealers about their business right now. You are not alone out there feeling like you need to do something. The guy next door maybe a survivalist now and you don’t even know it. Do you have stuff stored in your basement? If you do, guess what, your part of the growing crowd. Take my advice, if you can start preparing a little at a time. Money is tight I realize this, but if you can work on it if you have not already started. People need to understand, perception becomes or is reality most times. People are feeling threatened and vulnerable and our government is not doing anything to help, as a matter of fact they may be the cause for some if not most of it. A calm steady hand we do not have at the helm. One incident could start thing ball rolling, don’t be in its path when it does. TEOTWAWKI or not, a few extra bucks saved now will never hurt you late

Posted by BLW at 6:53 AM

First Aid Primer

How about a little refresher course on very BASIC first aid. Why did I choose this topic?

Because... a couple weeks ago I witnessed a auto accident. It happened right in front of me. One auto was totally disabled while the other pulled over to the far right of the highway. I pulled over, turned on my flashers and went to the vehicle that was disabled. The driver was a bloody mess. I called 911. And I kept thinking I wish I had a first aid kit. Well, thank good the emergency vehicles came quickly. By the way - NO ONE stopped to help or assist. When all was said and done and I got back in to my vehicle and it was then that I realized I had a CERT bag that contained a very large and complete first aid kit.

So this is a review for me too.

FIRST AID PRIMER

If you encounter someone who is injured, apply the emergency action steps: Check-Call-Care. Check the scene to make sure it is safe for you to approach. Then check the victim for unconsciousness and life-threatening conditions. Someone who has a life-threatening condition, such as not breathing or severe bleeding, requires immediate care by trained responders and may require treatment by medical professionals. Call out for help. There are some steps that you can take, however, to care for someone who is hurt, but whose injuries are not life threatening.

Control Bleeding

• Cover the wound with a dressing, and press firmly against the wound (direct pressure).
• Elevate the injured area above the level of the heart if you do not suspect that the victim has a broken bone.
• Cover the dressing with a roller bandage.
• If the bleeding does not stop: 1) Apply additional dressings and bandages and 2) Use a pressure point to squeeze the artery against the bone.
• Provide care for shock. 

Care for Shock

• Keep the victim from getting chilled or overheated.
• Elevae the legs about 12 inches (if broken bones are not suspected).
• Do not give food or drink to the victim.

Tend Burns

• Stop the burning by cooling the burn with large amounts of water.
• Cover the burn with dry, clean dressings or cloth.

Care for Injuries to Muscles, Bones and Joints

• Rest the injured part.
• Apply ice or a cold pack to control swelling and reduce pain.
• Avoid any movement or activity that causes pain.
• If you must move the victim because the scene is becoming unsafe, try to immobilae the injured part to keep it from moving.

Be Aware of Biological/Radiological Exposure

• Listen to local radio and television reports for the most accurate information from responsible government and mediacl authorities on what's happening and what actions you will need to take.
• The Web sites referenced at the end of this brochure can give you more information on how to protect yourself from exposure to biological or radiological hazards.

Reduce Any Care Risks

The risk of getting a disease while giving first aid is extremely rare. However, to reduce the risk even further;

• Avoid direct contact with blood and other body fluids.
• Use protective equipment, such as disposable goves and breathing barriers.
• Wehnever possible, thoroughly wash your hands with soap and water immediately after giving care.

--American Red Cross

So I can testify it is important to be prepared for an emergency and to know how to give emergency care!

~Karin

The Best Self Defense/Survival Pistol Ever?

The 1911 Government Model may be the Best Self Defense/Survival Pistol Ever

You know from time to time something comes along that just withstands the test of time. In the case of the Government Model pistol, it not only withstood the test of time, it rewrote the book on how time is measured. It is probably the single best example of a pure defensive pistol ever made. It was built with one job in mind, stopping the enemy. Which by the way it did, does and probably always will. Why is it still at the top of the game after over a hundred years, how about a couple reasons most people don’t think about.Look at the number of companies making this weapon now, think of it top of line custom gun firms like Wilson Combat, Nighthawk Custom and Ed Brown, then look to the leading firearms manufacturers in the business like Kimber, Sig, Springfield Armory, Smith & Wesson they all make and market a version of the 1911 Government Model. Just to be sure, don’t ever forget Colt, that would be the “C” in the Automatic Colt Pistol part of 45 acp. The weapon was replaced in active military service in the 80′s, but many elite military units still carry them today.

Try this out, the pistol is easy to clean and maintain without much as far a tools go. It is a rugged design that was made to be abused. The weapon itself is pretty simple, Browning knew what he was doing, he knew he needed a weapon that could keep running with minimal care in dirty conditions. This pistol has served in World War 1, World War 2, the Korean War and the Vietnam War and is seeing service in Afghanistan and Iraq today. The original government model used the now famous 45acp round, which is just a a bit under a ray gun in stopping power. Now you need to remember the military still uses only full metal jacket ammo, the old saying “they all fall to hard ball” still fits. If you need to shoot at someone with fmj ammo, 45acp is by far the way to go. So there we have a weapon design and a caliber, now we have a weapon built for speed. Once the weapon has a round chambered and the hammer is “cocked and locked”, which is the only way to carry the weapon for real, this pistol is flat out fast. It has a natural point-ability like no other pistol. The shooter who uses a 1911 many times just gets hooked on the great trigger and feel the weapon has. Jeff Cooper made the entire world change in defensive pistol shooting and he based his advice and techniques on the 1911.
Now we know the history what about the current state of affairs? Today we have more good to great 1911′s on the market than ever before. You don’t need to have a custom pistol any more to have a fantastic government model. Take Kimber for example. They offer features on their pistols once only found on custom weapons. One big improvement many over look is in the sights. Great sights are now standard on many of these pistols. Night sights are now standard for Kimber on their defensive pistols. The original government models had a little blade on the front and a plain leaf in the back, not anymore. Years ago you spent hundreds of dollars at a gunsmith just having usable sights put on. Accuracy, today these weapons are at the top of the heap in the accuracy department. Many of the top brands are looking at 1′ groups at 25 yards, what else do you want? So now we have a weapon with a big hard hitting round, its accurate, easy to maintain, easy to shoot and fast on target whats left? Reliability comes to mind. The one issue you need to watch is the magazines. Many cheap surplus deals are out there, most aren’t worth the room they take up. Mags by Wilson Combat, Kimber, Ed Brown and others make a huge difference when the chips are down. The weapon makers have worked out most of the bugs, one thing people don’t realize is that getting the pistol to feed ball ammo is the hardest thing to do. A lot of ammo varies in length and ball ammo is the worst for it. Be sure to try any magazine you intend to use for serious purposes before you depend on them. Most times, not all, a pistol that doesn’t feed well is nothing but a magazine problem.
A lot of gun people out there say why even bother with the government model, why not go with a Glock or a Sig? To be sure they are great weapons. They would and do serve well as defensive pistols. Also, if you are going to use a government model you should practice, and practice and then practice some more with the pistol. Drawing the weapon a not taking off the safety could really get ugly if you need to shoot. Trigger finger control and discipline are a must with a 1911, you can’t touch that trigger until you are ready to fire, with the short trigger stroke there is no room for error. Could holding a person at gun point be harder with a 1911? I suppose the answer could be yes, but you should never have your finger on the trigger anyway until you are ready to shoot. Look at the top SWAT teams in the country, the FBI HRT, LAPD Swat, the US Army Delta and the list goes on, what they all have in common is the 1911 government model pistol. When the US military’s SOCOM wanted a new pistol they looked at the 45acp first and last. When the US Marines wanted a harder hitting pistol guess were they went looking, at the 1911 and out came the military version of the Kimber Warrior.
With a series of pistols in all sizes to fit almost any need now, there is not much the government model really can’t do as far as a defensive pistol goes. You could do a lot worse than have a government 45, stuck to your side. Most new mags hold 8 rounds in the full size pistol which gives you plenty of firepower to take care of most situations you may find yourself in. With an extra mag or two your good to go for most adventures you may end up on. Combine a big hard hitting round with a great durable design and what you get is another 100 years of protecting Americans at both home and abroad. Until we get Captain Kirk’s phaser Americans will be carrying government models. And even then they will find a way to make it feel like a 1911.

Posted by BLW at 5:38 AM

Those Who Profess to Favor Freedom...

"Those who profess to favor freedom, and yet depreciate agitation, are men who want crops without plowing up the ground. They want rain without thunder and lightning. They want the ocean without the awful roar of its waters. This struggle may be a moral one; or it may be a physical one; or it may be both moral and physical; but it must be a struggle! Power concedes nothing without a demand. It never did, and it never will. Find out just what people will submit to, and you have found out the exact amount of injustice and wrong which will be imposed upon them; and these will continue until they are resisted with either words or blows, or with both. The limits of tyrants are prescribed by the endurance of those whom they oppress." - Thomas Paine