I originally posted this as a reply at the end of another thread. But I figure it might be helpful for some people.
As a background, I'm an ER doctor, so wounds are what I deal with.
Here's some advice on wounds:
1. Make sure your tetanus is up to date before you go out. Tetanus is a spore former and most likely to be contracted with dirty wounds. specifically, rust and dirt. Yes, regular old hiking trail dirt has lots o' tetanus. And odds are you may have some dirt in your wounds. The recs, if you've had a fully vaccination series in the past (and if you're from the US you have), are for a tetanus within 5 years for wounds at high risk (dirty wounds, deep wounds, improperly irrigated wounds), and 10 years for other wounds. So, 5 years. Of note, ANY wound can carry tetanus.
2. Studies have looked at all of the aforementioned issues and the only thing that has really been shown to help wounds is irrigation, irrigation, irrigation. I don't really know much about the bloodletting approach, but hey, knock yourself out. Wound infection rates are inversely proportional to the volume of irrigation AND THE PRESSURE WITH WHICH IT IS APPLIED. That's key, thus the shouting. a little 3 cc syringe is pretty crappy. You can get pretty decent pressure with 10 cc. In the ED I use a 20 or 50 cc syringe for dirty wounds. Don't drip water into the wound, spray it in. If you are near a sink a faucet opened all the way does a pretty good job. Making a pressure bag with a big ziplock, or spraying through pressure using a hose from your water filtration device can be useful too.
3. You gotta get out foreign bodies. Leaving a rock or gravel or glass etc. in a wound will highly increase your risk of infection. If you need to use tweezers or more irrigation or your finger, then sterilize the best you can and JUST DO IT! swoosh. If you think there is stuff in it, don't close it.
4. If the wound is deep, then get out the gunk, wash it, then wash it again, wrap it, and be hesitant to close it. We will leave dirty dirty wounds open a few days and then perform a appropriately named delayed closure 3 or 4 days later if it doesn't look infected at that time.
5. Don't use alcohol, or hydrogen peroxide, or iodine or whatever on your wounds. It can be helpful to use a little hydrogen peroxide on a really dirty wound if you can't immediately wash it. It also MIGHT be helpful to mix in a small amount of iodine with your irrigation water. This should be a 10:1 dilution. Be sure to rinse the iodine water out prior to closure. i say might because studies are inconclusive. Since the water may be out of a bag you've been sucking on for 10 miles, I imagine the iodine technique might be a good idea. Don't use hydrogen peroxide, alcohol, iodine etc after you've washed. These things work by creating an environment that kills bacteria. That being said, they also kill healing tissue.
6. Irrigation is key. What you close something with, be it steri strips, stitches, duct tape, superglue, etc., is less important. Studies are limited. There is a study that show that washing a wound under the faucet for a few minutes and then duct taping does just as well as stitches and sterile technique for finger wounds under an inch. I would hesitate to close any deep wound (like a 2 inch deep thigh wound) where there might be a potential space left underneath. In other words, where the top is closed and there is a big unsutured deep cut that isn't pulled together. That is a big space that bacteria love. Warm, deep, with pools of protein. You should also not close deep punctures (stab wounds and gunshot wounds in the er are not sewn up). Of note, did you know that superglue was originally made by the military as a wound closure for field use in Vietnam? It works pretty well for small wounds. There's a little easier to use product named Dermabond although I don't know the availability for nonmedical people.
7; After you've closed something, wash with simple soap and water. I would cover with a antistaph/antistrep antibiotic. Bactroban/bacitracin is a good choice.
8. If you are close to society and get cut, typically wounds can be closed on the body for up to 12 hours. They can be closed on the face for up to 24 hours. If you show up later, they will be washed and then possibly sewn up in 2 or 3 days if there are no signs of infection.
9. Prophylactic oral antibiotics are not a good idea unless a wound is contaminated. Antibiotic ointment won't hurt.
10. If you close a wound and it gets infected, open it up. Let the pus get out, and irrigate it. Staph makes little pockets of pus in a wound that need broken up. If you get it you'll know. Got thick yellow snot coming out of your cut? That's staph. Pop those vicodins you carry, open the wound, wash like hell, and try to break up the walls very gently with your washed and alcohol cleaned finger if you don't have gloves. Don't ignore your big pus filled wound. See a doc fast. And start up some antibiotics! Pus is usually staph. You should have strep coverage too.
11. Wounds you obtain in water are another beast. As are punctures through your shoe. As are bites. Those are high risk and need antibiotics, but you have to know which ones as they are special situations.As are a lot of other situations.
Anyway, I hope that helps!
