OK
4 sites that also can give info as to when not to.
The first, second, and the last are self doable. The 3rd one will involve money and travel for a class
http://thepreparedninja.com/xx-reasons-suture-wound/ Here are some of the most common reasons that a wound should not be sutured (contraindications):
1. Any wound that is more than six hours old.
2. A wound that is dirty with severe contamination that requires extensive cleaning or debridement.
3. Some concave skin surfaces like the temple is best healed through secondary intention (natural healing).
4. Complex structures like the eyelid require complicated repair and should not be closed.
5. Damaged tissue, especially in severe wounds, crush injuries, and gunshot wounds.
6. Any bite wounds whether from an animal or a human.
7. All open fractures.
8. Absorbable sutures should not be used where prolonged approximation (joining) of tissue under stress is required due to risk of potential tearing of the tissues.
9. If the patient is set to go on a long journey/prolonged travel.
10. All wounds that are a result of combat.
11. Any wound that involves a tendon, nerve, or major blood vessel injury.
12. Any wound that is so severe that anesthesia cannot be obtained without a toxic dose of local anesthesia or sedation.
13. Silk sutures should not be used in any patient with an allergy to silk or silk products as well as in any location where permanent retention of tensile strength is required.
14. Most open joint wounds.
15. A wound should not be closed if antibiotics are not available to treat an infection if one becomes present.
16. If the patient has a known allergy to collagen or chromium, neither plain or chromic gut sutures should be used to avoid potential allergic reaction.
17. The wounds of a patient that is in severe shock should not be closed because of the risk that poor peripheral circulation could hinder proper wound repair and healing.
18. Avoid suturing a wound that may have to be treated with skin grafting (degloving injuries, etc.)
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With all of that being said, while the reasons listed above are all reasons to not suture a wound, many of these reasons are just indicators to delay closure of the same wound. You can take several of the reasons listed above to not suture a wound and change the circumstances by introducing the ability to clean the same wound or the availability of antibiotics and the reason to not suture the wound is gone. This may delay the closure but does not ultimately rule out sutures in the long run.
Three page set of guidelines, with illustrations, from the World Health Organization. They send people out into the Mud, Blood, and Beer. A lot of their guidelines are based on Austere medicine
http://www.who.int/surgery/publications/WoundManagement.pdf===========================================
A class from Dr. Bones and Nurse Amy
https://www.doomandbloom.net/medical-classes/ Description:
Complete Wound Care Class Description:
Learn how to provide
complete wound care with hands-on suture training, as well as stapling with Dr. Bones and Nurse Amy, medical preparedness experts from DoomandBloom.Net. Using a pig’s foot, they’ll show you how to assess a wound, apply antiseptic, insert the sutures, tie a proper instrument knot, cut the extra sutures and learn how to space the sutures for proper wound closure.
Also, know how & when to use staples and, most importantly, learn when NOT to close a wound.
Wound care is also discussed in detail! This course is designed for the non-medical professional and those medical personnel without suturing knowledge.
Want to figgertit out yourself?
Wound closure manual – pdf, 80 out of the 120+ pages – useful – the rest – ads for suture.
http://www.uphs.upenn.edu/surgery/Education/facilities/measey/Wound_Closure_Manual.pdf