Innovative Wound Care

[fisherdvm]

I am very hesitant to recommend superglue or any kind of tightly occlusive dressings, unless I am certain the wound is very clean, not infected, and not contaminated.

I have had to clean up infected facial wound held together by the medical grade of super glue by ER doctors. It is best to use sutures, and not resort to tissue glue. While tissue glue has a great place in medicine (I've repaired hernias in mice, glue closed declawing wound in cats) - these are very clean and healthy wounds.

The foot is dirty, contaminated, and known for poor healing. I would not dare to recommend anything but professional wound care (not just by any doctors) for this wound.

 

[Sideband]

You could wear a dry suit...

 

[Kevrumbo]

Kevrumbo,

Do you just let it peel off when it’s ready, or use it like New Skin? New Skin recommends using more of its liquid to take off previous coats when it is still wet.

Taken from the same source (Cyanoacrylate): - Wikipedia, the free encyclopedia

"The original Eastman formula was not FDA approved for medical use, however, because of a tendency to cause skin irritation and to generate heat. In 1998 the FDA approved 2-octyl cyanoacrylate for use in closing wounds and surgical incisions. Closure Medical has developed medical cyanoacrylates such as Dermabond, Soothe-N-Seal and Band-Aid Liquid Adhesive Bandage."

So New Skin may very well be a derivative of cyanoacrylate glues marketed under another name.

Thanks,

AZ

As with anything, discontinue use if you exhibit signs of skin irritation.

I mostly use a little dab of generic super glue for simple dry skin fissures and paper cut type lacerations on my fingers and the heels of my feet, especially after several days of liveaboard multi-dives.

Just leave it on, and by the time the coating falls off, the wound will be approximated/closing (if there are no complications).

ArcticDiver's wound sounds more complex, and would need diligent care, as prescribed by the Doc's above, at the end of every dive day. . .

 

[ZenDiver.3D]

PLEASE NOTE! I am not a physician!! Just a story about superglue.. As a kid,(100 years ago), I was a competitive ranked gymnast (this means working out 7 days a week on all equipment). There wasn't any girl there whose hands weren't raw meat daily. We call them "rips" because thick layers of skin will tear off your hands from working bars. Even then, new skin and superglue were used to cover bloody hands. I didn't say it the smartest thing, just the norm. We never had any problems. Of course, we weren't in the sea....

I recently superglued my husband's scalp wound. Cleaning thoroughly is key. Several layers and it was fine. He was diving three days later with his classes in the Arabian Gulf. I would not pretend to give this as medical advice, just our own dive fanatic experience by two long-time die-hard athletes who have done things like this with superglue for years, luckily, with no adverse reactions.
BUT!! I have never used it on feet! The foot represents a whole new ball game. I know from my own oyster-bed-with-bare-feet experience = sliced feet to the bone, including my big toe, most doctors won't even suture a lot of foot wounds because of the infection issue. Can any of you real docs add to that?
Be careful, go see a live doctor, in person, explain what you want to do, and take their advice. Not mine, (all due respect to you learned MD's out there). I offer only my opinions, personal experience, and anecdotes. And it is all worth exactly what you paid me for it. Good luck.

 

[fisherdvm]

If you intend to use superglue, it might be interesting to read this article. It warns about the harmful effect of over the counter superglue vs. the medical grade stuff used by the ER. Although superglue can be used, you might want to read the high lighted parts:

Super Glue for Wound Closure

Quinn & Kissick, 1994) Current use: Although not labeled as such, over-the-counter Super Glue products contain methyl alcohol, because it is inexpensive to produce. Cyanoacrylates cure by a chemical reaction called polymerization, which produces heat. Methyl alcohol has a pronounced heating action when it contacts tissue and may even produce burns if the glue contacts a large enough area of tissue. Rapid curing may also lead to tissue necrosis. Midwives have not noted such reactions because minimal amounts are being used for perineal repair. Nevertheless, with a greater toxic potential, over-the-counter products are inappropriate for use in wound closure. (Quinn & Kissick, 1994)

Medical grade products currently available contain either butyl, isobutyl or octyl esters. They are bacteriostatic and painless to apply when used as directed, produce minimal thermal reaction when applied to dry skin and break down harmlessly in tissue. They are essentially inert once dry. Butyl products are rigid when dry, but provide a strong bond. Available octyl products are more flexible when dry, but produce a weaker bond.

 

[fisherdvm]

I have personally used superglue a few times for fissures in my thumb from too much alcohol exposure. But it is only a small amount, and not a large wound - where heat and tissue toxicity could be a factor.

 

[ZenDiver.3D]

If you intend to use superglue, it might be interesting to read this article. It warns about the harmful effect of over the counter superglue vs. the medical grade stuff used by the ER. Although superglue can be used, you might want to read the high lighted parts:

I never said it was the wisest thing to use. I was just explaining what a few of us who were long time athletes have used superglue for. I agree that it is NOT the best, but will work in a pinch. I used it over dermabond on my hubby because I was out of dermabond, and hospital sutures in Kuwait-----uugghh. The gauge of sutures looks like twine... I would rather take the superglue risk on that one.

But, like I said, feet are a whole different ball game, and I definitely defer to you MD's. My athletic career is chock full of going against sound medical advice and powering on, because I HAD to compete.... I even played A-league softball international tourney with a shattered ankle and torn ligaments- because 2nd base is Mine, and I lead the region in double plays..... That was 2 years ago. See- dumb jock then- and now. It is amazing the things we do....:14:

 

[fisherdvm]

No, I didn't say superglue is a bad thing. I used to work for a vet hospital that used over the counter superglue instead of "vet" grade glue. They tried to save a few pennies - the cats healed fine from their declaws. But personally, I am a stitching kind of person. But with enough experience, I am sure one can use superglue and get good result in wound care.

Other options rather than stiching up wounds?

Giant soldier ants. You pinch the wound edges together, let the ants bite the edges. Pinch the body off the head. The mandibles get locked in a closed position..... And you get an automatic wound staple !!! Not highly recommended, as some ants are venomous and secretes toxic enzymes from their mandibles.

Use your hair to suture a scalp laceration: Find bundles of hair immediately next to the wound edges, and tying them together. It probably would work well if you isolated just a few hair spaced across the scalp wound. Hemostasis in the scalp is difficult - but it has been reported.

 

[TSandM]

By the way, I completely agree with fisher about foot wounds being problematic, prone to complications, and requiring careful attention, especially in older adults. I also agree that peroxide is a good debriding agent; it's simply that clean, well cared for wounds shouldn't need a lot of debridement.

The wound described in the original post is a difficult one. For good healing, a wound needs a lot of things: It needs a good blood supply, which is ALWAYS problematic in the lower extremity. It needs not to be subjected to a great deal of shear forces, which is a problem in the foot. It needs to be kept free of debris and fibrin accumulation, which can be done by gentle mechanical cleansing, with water or dressing materials, or with chemical debriding agents. It needs to have the bacterial count kept down, which is possible with good hygiene, and probably better done that way than with antibacterials, unless one of the good wound agents like Silvadene is used.

There are a lot of things that go into healing an open wound, and the number one is covering the wound with something that recreates an at least pseudo-normal tissue environment (eg. skin graft or pigskin). The wound described certainly needs evaluation by a physician who is familiar with lower extremity wounds and what is required to get good healing there.

My reading of the original post was simply that the author was requesting descriptions of non-traditional methods of managing simple wounds, and that's what I offered.

 

[ArcticDiver]

TS&M:
You are right on. I believe I'm qualified to handle traumatic injuries such as this and to know when I need to call for more expertise. That fact that this wound is healing quite nicely verifies that I made the correct decisions. Of course, the fact that for an old guy, or most people for that matter, I've got very robust healing and immune systems doesn't hurt at all.

This thread was put up, as you surmised, primarily to get input on non-traditional wound care that a person might consider when seeking professional care just isn't practical. Your input was right on target.

It is never too soon to learn and plan for how a person would handle a traumatic injury, or like in this case a multi-trauma injury, while away from the comfort of home.