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1/10/2017 10:36 AM
 

Also...just to add to my post prior to this one...I have full mobility of my thumb, no nerve issues, and no discomfort from the scar.


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1/10/2017 11:27 AM
 

Additional subject matter regarding the use of superglue for wounds.  

http://mayoclinichealthsystem.org/hom...

The photos & write-up I posted earlier today regarding use of superglue on my own laceration probably serves as an example of pushing the envelope on just how far the use of superglue can be taken.  It was a pretty good sized wound and into the muscle of my palm, but I felt confident I could get it to close with the superglue based on no tendon or arterial involvement, and also from having had a good amount of past experience using it on Indig folk OCONUS.

Of course, this was in a situation where I did not have any viable alternative, other than skip out on the jungle training and return to Lima.  Well...I certainly wasn't going to miss out on the jungle training, especially since I was a primary instructor.  Plus...that's me!  Go big or go home...if you're gonna be a bear, might as well be a grizzly!


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1/10/2017 11:39 AM
 
Did you have Dermabond or was it hardware store glue?  The thin cyanoacrylic glues will wick down into a wound.  Not good.  It needs to be a gel-type glue.  Some of the fishing superglues (for knots) are gels.
 
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1/10/2017 11:44 AM
 
Take-a-knee wrote:
Did you have Dermabond or was it hardware store glue?  The thin cyanoacrylic glues will wick down into a wound.  Not good.  It needs to be a gel-type glue.  Some of the fishing superglues (for knots) are gels.

TAK, it was Loctite brand gel, from Lowe's!  Did you see the photos and write-up about the situation on the previous page?  No doubt, it was a pretty good slice.


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1/10/2017 2:00 PM
 
Ken, there is super glue and there is super glue...Is there any particular brand that you recommend over the others? I've found some that do not dry that well nor does it appear to adhere that well to skin...Just curious. Thanks.
 
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1/10/2017 2:36 PM
 
El Mac wrote:
Ken, there is super glue and there is super glue...Is there any particular brand that you recommend over the others? I've found some that do not dry that well nor does it appear to adhere that well to skin...Just curious. Thanks.

I've had good luck (recently, obviously) with the Loctite brand gel.  In years past, I've actually carried and used the original Krazy Glue that comes in the little hard plastic case.  However, like TAK stated, the liquid kind can wick down into dermal tissues, which isn't a good thing.  That said, the original Krazy Glue does stick to skin like nobody's business.  I think Krazy Glue now has a gel version.


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1/10/2017 2:46 PM
 
The key is, as El Mac pointed out, use of the term super glue. Like say xerox, jacuzzi, duct tape, etc... it is now a generic term and effectiveness and ingrediants vary widely. Years ago during med training in the FS we where advised that the ingredients of crazy glue had changed and now included an ingedient that was toxic when used internally like an opwn wound. In the field you are going to do what you are going to do, but personally I would recommend non-toxic.

Co-Owner Hill People Gear "If anything goes wrong it will be a fight to the end, if your training is good enough, survival is there; if not nature claims its foreit." - Dougal Haston
 
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1/10/2017 3:27 PM
 
scothill wrote:
The key is, as El Mac pointed out, use of the term super glue. Like say xerox, jacuzzi, duct tape, etc... it is now a generic term and effectiveness and ingrediants vary widely. Years ago during med training in the FS we where advised that the ingredients of crazy glue had changed and now included an ingedient that was toxic when used internally like an opwn wound. In the field you are going to do what you are going to do, but personally I would recommend non-toxic.

I stated the brands I have most often used.  Additionally, if the wound edges are held together while the glue is being laid down, and then held in place until the glue dries (about 30 seconds to a minute), there is relatively little risk with it being taken internally.  I think since I have used all manner of superglue (brand non-specific) on wounds over a couple decades and in several countries gives me a decent enough level of experience with what can be done with it, when needed.  


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1/10/2017 4:04 PM
 
alpendrms wrote:
Take-a-knee wrote:
Did you have Dermabond or was it hardware store glue?  The thin cyanoacrylic glues will wick down into a wound.  Not good.  It needs to be a gel-type glue.  Some of the fishing superglues (for knots) are gels.

TAK, it was Loctite brand gel, from Lowe's!  Did you see the photos and write-up about the situation on the previous page?  No doubt, it was a pretty good slice.

 Oh, yeah, I saw it.  I'd have bet that it would not have worked without casting a splint and immobilizing that hand.

 
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1/10/2017 4:21 PM
 
Take-a-knee wrote:
alpendrms wrote:
Take-a-knee wrote:
Did you have Dermabond or was it hardware store glue?  The thin cyanoacrylic glues will wick down into a wound.  Not good.  It needs to be a gel-type glue.  Some of the fishing superglues (for knots) are gels.

TAK, it was Loctite brand gel, from Lowe's!  Did you see the photos and write-up about the situation on the previous page?  No doubt, it was a pretty good slice.

 Oh, yeah, I saw it.  I'd have bet that it would not have worked without casting a splint and immobilizing that hand.

I'll admit...I did have my doubts, especially out in the nasty conditions we were in.  I had to put up my hammock, process wood for my Solo Stove, hump around the jungle hills, etc.  I just kept up on the dressing changes and kept a good eye on it.  What can I say?  I reckon us SF people are just made out of hardy stock!  Probably would've killed a normal man!  ;-)

 


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1/10/2017 5:35 PM
 
Alp - really cool stories. I'd suggest that perhaps were my EM friends and you diverge on your opinion of super glued wounds, is that they usually see them after something has gone wrong (infection), and that the cleaning and application wasn't done by an experienced medic. And, supergluing a cut might protect it and keep an individual "in the fight" when there aren't other options - whereas your average hunter or outdoorsman normally isn't in quite the same situation as you in the jungle, or an indig where there are no or poor medical services. Also, thanks for sharing that Mayo link - pointing out the child-and-needle bit (or adult-afraid-of-needles) really got me thinking.

I had a question regarding one of their comments: "Skin adhesive is an alternative that can be as effective as stitches when used on the appropriate wound. Usually, that means a small wound; not very deep or wide; not “dirty” or prone to infection; and not on highly mobile parts, such as joints."

Why would I want to superglue that type of cut? To prevent dirt or debris from getting in it and potentially causing an infection when in the field?

- J
 
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1/10/2017 6:06 PM
 

J - Cool.  Yeah...I think that some of the caveats they threw into that article was to cover their butts.  Now...over a joint....that makes sense.  

The way I treated that wound was not rocket science.  If hunters and others that were faced with a similar situation...far from definitive care...but at least cleaned the wound properly, with lots of irrigation...primary closure with super glue isn't really that dissimilar than standard sutures.  But yeah, I get your meaning.  Many out there are not contientious enough to adhere to the tenets of sound wound management...so that's when infection shows up.  If one can be vigilant and through with the cleaning, that goes a long way toward thwarting infection.


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1/12/2017 2:59 PM
 
alpendrms wrote:

J - Cool.  Yeah...I think that some of the caveats they threw into that article was to cover their butts.  Now...over a joint....that makes sense.  

The way I treated that wound was not rocket science.  If hunters and others that were faced with a similar situation...far from definitive care...but at least cleaned the wound properly, with lots of irrigation...primary closure with super glue isn't really that dissimilar than standard sutures.

 I'd argue that Dermabond on the skin is less invasive than sutures.  My SIL just had surgery on her neck.  Internal sutures and the skin was closed with Dermabond.

 
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1/13/2017 3:47 AM
 
I have had the fortune of having some very good instructors and mentors in the field of medicine, and one said (as a rhetorical question...and I'm paraphrasing), "There is no good reason why you cannot use more than method to close a wound".

2 of the techniques that we discussed:

Steri-Strip + tincture benzoin works very well (NOLS/WMI teaches this)
duct tape flaps closer together, then using sutures/fishing line/dental floss to close it up (overlappping the duct tape flaps) works as well...without puncturing the skin.

I am sure many of you have other ideas...if tincture benzoin isn't available, superglue (even with toxic ingredient) on the skin as a additional bonding agent for something else might be a possibility?

My $0.02. Looking forward to hearing more ideas from all y'all.
 
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1/17/2017 10:27 AM
 
The last two times I have cut the fool out of myself here at home I have had the misfortune for them to both be when my wife was out of town.

So, I could not have her go through the Med Kit and get out the appropriate supplies. And the last one was..well...impressive. Not like that gash on your thumb but a good bleeder.

So I bounced down to the Doc In A Box (Urgent Care) about a mile away.

They superglued them both times.

Now it was the FDA approved Liquiband labeled stuff. But...it was Cyanoacrylate . We used it all the time in surgery on scalp wounds. Post-craniotomy it was a better option sometimes than skin staples or stitches. Especially on kids who the blood flow interruption to their scalp might affect their hair growth. I got the guy at the doc in a box to give me a few of the applicators they had since I admitted to having done it to myself (and others) quite a few times.

As for correct use for wound or such. My mother taped up a 5 inch cut on my leg that as an adult ended up having been deep enough to affect cutaneous nerve response with SCOTCH TAPE!!! (She A: Hated doctors B: Was terribly practical) As for your palm gash, you made the best decision based on the situation and you were responsible for your own care and I am sure observed the wound for signs of infection, edema and secondary toxicity from the glue. Sort of my point in the earlier post. Training + Common Sense + Accountability = Successful Field Medicine!
 
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1/17/2017 10:38 AM
 
"something else might be a possibility?"

Pine Sap. Or any conifer sap really but we have bloody pine trees here in NC and that is that.

Pine sap and a piece of flannel torn from a shirt tail was one of the most impressive improvised wound closures. Saw it at a NOLS Survival Seminar some years ago. Cut a gap in the cloth and teased out the threads to sort of weave across the actual wound as to not put undue pressure on the cut and to allow for drainage. Asked the guy where he learned it and he said his dad had been a roofer and they would use tar and a rag and the idea just sort of struck him one day while playing with a chunk of sap.

I have read of just using the sap. Handle it until it becomes semi-solid and the stretching creates a web and then while someone pinches the wound shut lay the web of sap over.
 
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