Nov 23 2016
Originally published at Paddling.net on 27 September 2016
A Note to the Reader: I am not a physician, and though I find the approach described in this article useful, there are unavoidable risks whenever a layman* chooses to “play doctor,” whether the patient is himself or a companion. So be sure to consult a trusted physician before employing the techniques outlined here — and then follow her recommendations to the letter.
One more thing by way of reassurance: No writers were injured in the making of this column.
A well-stocked first-aid kit is one of the Ten Essentials, and on trips to remote areas, the scope of “first aid” necessarily broadens. When professional medical help is many hours (or even many days) away, canoeists and kayakers may be called upon to become medics, treating problems that would warrant a trip to the ER if they occurred at home. This is why getting formal instruction in wilderness medicine should rank high on every venturesome paddler’s to-do list.
Deep lacerations are a case in point. The paddlers’ world is full of sharp objects: knives, axes, mussel shells, coral, half-submerged barbed-wire fences, broken beer bottles… Any of these can slash open your tender flesh in less than a second, and no matter how careful you are, accidents do happen. Standard first-aid is limited to stopping the bleeding (by direct pressure) and then protecting the wound with a gauze compress or similar dressing. That’s fine if you’re only a 15-minute drive from the hospital. But what if you’re kayaking in Arctic waters, the wind is blowing half a gale (and rising), and visibility is down to 100 yards, with no prospect of improvement in the next 36 hours? Or suppose you’re camping next to a beaver pond, with your car two strenuous days of paddling and portaging away, in an area with no cellphone coverage. What then? You’ve got a deep open wound. And you need to close it. So… What do you do after you’ve stopped the bleeding?
Once upon a time, paddlers in remote areas were encouraged to suture gaping wounds as soon as they’d been thoroughly scrubbed and debrided, and some wilderness medicine handbooks devoted several pages to the technique of stitching human flesh. But that advice has long been consigned to the museum of medico-historical curiosities. A good thing, too. It’s difficult enough to clean a contaminated wound properly in a hospital setting. Doing so in a riverbank camp borders on the impossible. And stitching a contaminated wound closed is asking for trouble — serious trouble.
Which is why the textbooks now suggest using wound closure strips (“butterfly bandages” or Steri-Strips). These allow you to approximate the edges of the wound, thereby facilitating healing, while still leaving gaps for any purulent discharge to escape. But in my (limited) experience, neither butterfly bandages nor Steri-Strips can be relied upon to keep a wound closed if the injured limb can’t be rested — as may well be the case if a paddler’s arm or leg is sliced open when he still has miles to go. In such cases, something more is needed. But what?
Well, how about …
It’s handy stuff, and most paddlers have a roll of this sturdy, reinforced tape in their repair kits. But duct tape is good for more than patching brutalized boats and torn tarps. It can also be used to mend a lacerated human frame. I didn’t dream this up by myself. I first learned of it from nurse practitioner and former British Army medic Chris Anderson:
Although living in the UK, whilst serving in the British Army as a medic I was canoeing in the Rockies around the Wainwright area in Canada some time ago. There was a Fire Ranger who took us for our survival training who was fantastic and thankfully put us in excellent stead in order to enjoy the wilderness for 10 days.
I remembered the lessons he taught regarding using what you have at hand in order to survive [the trek] back into civilisation, and to this end I have been using and teaching the techniques he taught us regarding the closure of wounds using duct tape.
Surprised? I was. But I shouldn’t have been. Duct tape has a lot going for it. It’s mighty tough tape, with a tenacious, waterproof adhesive. And it conforms well to uneven surfaces, while still retaining a measure of elasticity. In short, it’s ideally suited to closing gaping wounds on active limbs.
Of course, you wouldn’t want to apply it directly over a gash. The adhesive would likely irritate the raw flesh, and removing the sticky tape later would almost certainly reopen the wound. But Chris let me in on the secret. And now I’m passing the word along. So here goes:
How to Use Duct Tape to Close a Wound
I’m assuming that you’ve stopped the bleeding and cleaned the wound — and that you have a dressing ready to put in place once you’ve brought the edges together. I’m also assuming you have the following items in your repair kit:
- Duct tape
- Stout, clean thread or a suitable substitute†
- Needle and strong thread
† Possibilities include thin strands teased from paracord, dental floss, or monofilament.
Now let’s get stuck in. After stanching the bleeding and flushing the wound (use disinfected water and mild soap or detergent), proceed as follows:
1. Tear off two strips of duct tape. Three- to four-inch lengths are usually enough. (If the wound is longer than the duct tape is wide, overlap strips as needed. But three- to four-inch lengths should still be adequate.)
2. Cut two lengths of stout thread, each one long enough to extend one-half inch or so beyond the tape’s width. These will be used to reinforce the repair tape and prevent the tension stitches (see below) from cutting through.
3. Place the thread on the adhesive surface of each strip of duct tape, roughly one-half inch from one end, as shown at Figure A below. (The adhesive is colored pale gray in the illustrations; the tape’s outer surface, dark gray. The thread is orange.)
4. Fold the tape over the thread as shown in Figure B, then press the tacky adhesive surfaces together, trapping the thread in the crease (C). Repeat with a second piece of tape.
5. Now stick the prepared tape strips to the intact skin on either side of the gaping wound. (Make sure the skin is dry, and since duct tape often employs latex-based adhesives, think twice before applying it to the skin of anyone with a latex allergy.) The thread-reinforced crease should lie close to the edges of the wound without overlapping them (Figure D below).
6. Using more thread, place a running stitch between the tape strips, as shown in Figures E and F. You’ll need to double ordinary sewing thread, but button thread or any similarly sturdy stuff can be used just as it comes. Stop the end of the thread with a figure-eight knot to prevent it pulling through, and keep the stitches in the doubled portion of the tape (its outboard edge is shown by the dotted white line). Take great care not to stick the needle point in your patient’s flesh. He’s suffered enough already.
7. Continue the running stitch as shown in Figure G, maintaining just enough tension to bring the lips of the wound together.
8. Finish by tying off the working end of the thread. Now cover the closed wound with a light, sterile dressing.
OK. It’s time to get real. Well, realish, anyway. In the photo that follows, I used waxed nylon sailmaker’s twine for thread. It performed admirably. I drew the line at self-harm, however. Verisimilitude has its limits. I’ve indicated the “gaping wound” with red ink and cherry jam:
You’ll be happy to know that the patient survived.
What did I tell you? Have you ever seen a neater stitch-up? It should prove far more tenacious than a line of butterflies, too. Better yet, I already have everything I need in my boat repair kit. And so do you, in all likelihood. But if you really want to be prepared, you’ll, …
Make a Brace of Duct Tape Wound Closure Strips in Advance
I made a couple of sets in a trice, and it was much easier to do on a table at home than on a muddy riverbank in a downpour. Each strip was fashioned as shown above, but the finished strips were subsequently stuck to squares cut from the plastic lid of a (now-empty) can of ground coffee. I then placed the running stitch as already described, leaving a generous free end at the finish:
That being done, each completed closure was tucked into a ziplock bag and slipped into my “doc box.” Piece of cake.
The upshot? I’m now ready to close a gaping wound at a moment’s notice. I’ll just remove a prestitched pair of closures from their ziplock bag, put the strips in place, snug up the thread, and tie the end off. It couldn’t be easier. (Good-quality duct tape will retain its adhesive properties through several stick-unstick cycles, so there shouldn’t be any problem making the prepped closures adhere to dry skin after removing the plastic backing from the tape.)
A heartfelt thank-you to Chris, whose letter describing this ingenious wilderness expedient was the genesis of my article. Of course, I hope I’ll never have to use the knowledge I’ve gained in assembling my duct-tape wound closure kit, but it’s good to know it’s there. Just in case.
Duct tape probably isn’t the first thing you think of when you go shopping for first-aid supplies. It may not even be on your list, though thanks to nurse practitioner and former British Army medic Chris Anderson, I’m betting it will be in future. Then you’ll have what you need should you ever have to close a wound in the backcountry. A sticky situation? Certainly. But sticky situations are all in day’s work for duct tape. You could say that it’s just what the doctor ordered.
* Pace, any campaigners for gender-neutral language. I’m using “layman” in its conventional, inclusive sense. Neither of the two obvious alternatives appeals to my inward ear: “laywoman” is risible, only one step removed from “laylady” — and I was never much of a Dylan fan. As for “layperson,” it belongs to the same lumpish clan as “chairperson” and “congressperson.” Just typing it makes my back teeth itch. Should you feel strongly in the matter, however, simply substitute either alternative as you read. I won’t mind.
Further Reading From In the Same Boat
- Safety First — Staying Out of Trouble
A collection of columns on a common theme. And yes, prevention really is better than cure.
- “Beyond Band-Aids — Medical Handbooks for Paddlers”
- “Meeting the Challenge of Backcountry Medical Emergencies”
- “Doc in a Box: Building Your Own Medical Kit”
- “The Survival Kit That’s Always With You”
- “Ten Things No Paddler Should Be Without”
- “When Carrying the Ten Essentials Isn’t Enough”
- “The Other Ten Essentials, Part 1”
- “The Other Ten Essentials, Part 2”
- “Worst-Case Scenario: Plan to Survive!”
- “Worst-Case Scenario: Let Dog Tags Speak for You”
- “Off the Beaten Track: Thoughts on a Death in Maine”
- “Off the Beaten Track: The Secrets of Survival”
Questions? Comments? Just click here!