Thanks for the (fast!) reply.

Been there done that...clean her up and keep it covered...bones are whiter than I thought they would be?  I say practice SHTF now and if it gets infected bad then run to the Dr....just my opinion I ain't no Dr.

It's not the only reason.  The big one is after 24 hours, the flesh/ skin on the sides of the cut is basically dead.  Since it is dead, two things will happen 1) the stiches have a much greater tendancy to tear the skin since they don't have a good base and 2) the edges will not heal together.  I had a pretty bad gash on the top of my knee that required a number of stitches.  After about a day or so, the wound dehis'ed. Had to leave it open for about 4 weeks until it scarred over and clean it at least once a day.  Sucked.

Anyway, you want it cleaned before you stitch.  If you can't clean, don't stitch - it will need to drain regardless though.

Assuming you live in a first-world nation with decent water treatment, you can flush cuts with regular tap water.  You don't have to use sterile solutions.  Dilution is the solution to pollution.

And basic, pull-the-edges-together stitching is very simple indeed.  An MD earns his money on the more-complex stuff... and on knowing the anatomy, including when/what to stitch.

Curious what the OP did and how this works out.  Had he not said he saw bone self treatment may be OK.  I think if you see bone and have the risk of infection there then it ain't worth it to self treat.  I'm not a doc, but no reason to bring on a personal shtf thats avoidable...

ETA:  I think the whole idea of posting this on the internet asking for advice is funny as shit

Chapter 567, section 5, subsection 2378, paragraph 98 of Obamacare says you are a goner, now page 99 says if you made a sizable contribution to the commie foundation then you are eligible for a tetanus shot and stitches.  Dibs on the guns.

Bold, red emphasis mine.



Bone == DOCTOR
 

Not necessarily... but if it is dead, it should be debrided (cut away).

How to tell the difference?  

Dead stuff doesn't hurt, and doesn't bleed.

Agreed.  Flush it out.  Don't use peroxide, it does indeed inhibit wound healing.

There is no magic to stitches themselves, it is really about approximating the wound edges well, if this can be done with butterflies or glue/dermabond, or duct tape, the result is the same, that said, high tension areas are prone to burst back open if the thing holding them together is weak.  That is the primary advantage of stitches.  They hold together better.  I'm not a big fan of dermabond, I never feel like my closures look very good unless it is something simple and shallow.  I really only use it in kids that are not going to hold still for stitches and I don't feel like they merit sedation.  The problem with using duct tape or something similar is that if you are not careful, when you pull the tape off, you may open the wound back up.  Another closure method that I really like are staples.  I really need two hands to suture so if I cut my hand, I can't easily suture it closed so far my first aid stuff, I really like to have staple closures to be able to work on myself.  Also staples are the way to go for scalp lacs, you don't want to have to try to find the sutures to cut out among someone's hair when it is time to remove them.

Regarding the OP's specific injury, I don't know what he did, but he should have seen a physician for it, not necessarily just for the closure.  I would have closed it with suture and then I would have prescribed an antibiotic just to cut down on the chances of wound infection.  It looked like a fairly clean wound, but with it being down to bone, I really wouldn't want to run the risk of a wound infection that could turn into osteomyelitis (infection of the bone).

Did the OP get an infection and die?

Since there seems to be a lot of medical professionals here......



I have always been a big believer, perhaps falsely, in hydrogen peroxide.   It seems the doctors/EMTs etc. are not.  



I am aware that H₂O₂ does attack flesh as well as anything else in there; and I am familiar with the chemistry involved.



Most cuts and wounds I suffer tend to be dirty and not clean cuts....  at least in my mind, I want to kill anything that got in the cut.  So I typically flush with treated tap water,  for a bit, then hit it with a few rinses of H₂O₂ and then a final flush with tap water (to remove any remaining H₂O₂) before bandaging.
It seems a lot of paramedics recommend povidone-iodine complex for these instead of peroxide, though the action is fairly similar (free radical release, free iodine vs hydroxyls).   Is it due to the slow release of the free iodine, versus the speedy free radical attacks from the peroxide?    When you recommend against peroxide use, is it because people apply it and let it sit too long, which kills more flesh than is necessary, which slows down healing?   I'm just trying to understand the reasoning behind the recommendations against its use.

Had it been me, I would have washed as others said with endure 420. Cleaned more with beta, then derma bonde and butterflied it,then dermabond the butterflies.I have a finger and thumb splint I would have used. I learned all this from the past visits to the ER, before I tested NREMT.

HAving medical basic medical knowledge and supplies can save your ass and your wallet. Several nasty stomach flu's in the past. Having a few start kits,  tubing, NS, lomotil and phenergran saved hours in  the ER and achieved the same result.

I've had a wound on my heel for 6 months caused by a pressure sore from a cast. Weekly debridement, man is that a bundle of fun. I finally got declared healed yesterday. Debridment of dead tissue is not a problem, but they always want to get the wound down to the healthy tissue and to stimulate it, which means it hurts like hell, but it did the trick for sure.

I can't tell how bad it is from that picture but I will give you a tip about Superglue. Don't use it. Yes, it can work and the doctors use a form of Superglue. They don't however use the kind you buy at Walmart. There is a medical grade (sterile) version of everything used in the medical industry.
Long story short....I had an idiot relative that thought he was going to be a badass and just clean and Superglue an injury. He ended up on antibiotics for the infection that follwed. We are not in SHTF right now. Use the existing medical industry.
Are you having your wife pull your teeth or are you seeing a dentist? Use what you can while you can.

not really. i dont use iodine to clean wounds or to clean the skin before i start IV's because of the possible allergic reaction. i use sterile water to flush wounds and alcohol prep pads to clean IV sites.

you should have signed up for maggot wound cleaning. its starting to make a come back. they have(if you can believe it) medical grade maggots for wound treatments. the maggots will only eat the dead flesh and leave a clean wound behind. i know it sounds gross but it works.

http://www.timesonline.co.uk/tol/life_and_style/health/features/article1499049.ece

http://www.helium.com/items/621618-the-future-use-of-maggots-in-medicine

As I recall the only solution that's been shown to be both bacteriostatic and not kill fibroblasts was povidone iodine 0.001%.  Yes, that's 0.001% - a VERY dilute solution of the concentrated brown stuff.

It's not just that iodine and alcohol and peroxide and bleach kill healthy tissue and create a nice growth medium for bacteria.  They also inhibit the white blood cells that would be chasing down and killing bacteria, and they retard healing by screwing with the cells that lay down new connective tissue.

Again, if you wouldn't put it in your eyeball, don't put it in a wound.

Yes.

Absent the need to debride devitalized tissue, copious irrigation with clean tap water is generally all you need to do.

Cover it; ya big wuss

Irrigation solution — Isotonic (normal) saline is the recommended irrigation solution for uncomplicated wounds, although tap water may be an acceptable alternative [2,30-32]. In a prospective study, 530 children with simple lacerations were assigned to irrigation with isotonic saline or running tap water on even and odd days of the month, respectively [33]. Wound infection rates were similar in both groups (2.8 to 2.9 percent), suggesting that running tap water may be an acceptable alternative to isotonic saline, at least in selected (ie, non-bite) wounds. In addition, when easily available, warmed saline may offer a comfort advantage to room-temperature irrigation [34].

A dilute (ie, 1:10 mixture of povidone/iodine solution [Betadine®]) and isotonic saline may provide useful antiseptic activity for contaminated wounds. Betadine® surgical scrub solution should not be used for this purpose because it contains ionic detergent that may be toxic to wound tissue. Other antiseptic solutions (eg, chlorhexidine and hydrogen peroxide) sometimes are used to reduce bacterial contamination. However, some of these solutions may be toxic to wound tissue, have little action against bacteria, impede wound healing, or have other adverse effects [2,35,36].

The author uses isotonic saline irrigation for the irrigation of clean uncomplicated wounds and dilute povidone/iodine for dirty or bite wounds.


Taken from Uptodate

There ya go.

This is the end of day 4 in the life of this thread...  The OP hasn't posted since day 1!...  I hope he didn't die as a result of some of the (bad) advice on page 1 (of 3) of this thread...  

<I was glad to see an infusion of wisdom in pages 2 & 3! >

+1

If a doctor is available, I would see the doc and observe how he treats you.  Then ask how he would suggest you treat the cut of you couldnt get to a doc.

i just did the same thing to my knuckle. cleaned and superglued myself with no probs.