Episode 142 S4-18
Lacerated Muscles and Ligaments
Battle for the South Ch 18
Dr. Joe Alton
In a long term survival situation an increase in physical labor demands will also increase accidental injures. A fully lacerated muscle, ligament or tendon would very likely be a permanently rehabilitating injury in this environment. A ligament is a fibrous band of tissue that connects one bone to another. When it tears it is considered a sprain. When a muscle or tendon that connects muscle to the bone tears, this is known as a strain. Most of these sprains and strains are minor and the injured person can expect a full recovery as long as they give it the proper rest time and takes steps to ensure it is not re-injured. However, this will be a big challenge in a long term survival situation, where you have to perform certain physically challenging tasks to survive.
Healing time can be reduced if you keep your body in good shape, especially as you get older. As you age sometimes simple activities that you don't do on a regular basis can cause injury. The three grades of tears determines the healing time that an average individual will experience. The first grade is a minimal tear. There is slight pain and swelling. This grade will only take a few days to heal. The second type is a significant or macroscopic tear. This type of tear will have bruising, pain and swelling. Usually it takes about three to six weeks to heal. Now-a-days it is suggested that sports activities are halted but in a long term survival situation physical exertion may be difficult to avoid. The third grade of tear is a complete tear or rupture. This takes more time to heal. A torn hamstring or knee ligament may cause loss of use of the limb and surgery is usually required. An injury of this type will take three to six months to heal.
If surgery is not required use the acronym RICE to heal the tear. R stands for resting the joint or muscle. I stands for ice. You should ice the injury for twenty to thirty minutes every couple of hours for the first forty eight hours to reduce swelling and pain. Ice may be hard to come by in a long term survival situation. Utilize cold water from nearby natural water sources and stock "Shake n' Break" cold packs. C stands for compression. tightly wrapping the afflicted area helps to immobilize the muscle or joint and decrease swelling. E stands for elevation. The afflicted area should be held about twelve inches above the heart. Sometimes, when the injury is severe, people add an "S" on to RICE. The S stands for stabilization of the muscle or joint. This can be done with a splint. Slight movements can sometimes re-injure muscles or ligaments that are in the healing process and new injuries can be further aggravated while the patient is in transport to a medical area.
Anthony Russel's lacerated tendon: OUCH!
If you have a complete laceration of the skin that cuts down through multiple layers of body tissue the fist thing you want to do is flush the wound. If you suspect that it was in a very dirty environment you need to go completely overboard flushing and washing out the wound. Use an irrigation syringe so that you can forcefully flush the wound. If you believe that the wound is clean enough to close than you have to examine the injury and find out how many layers of tissue have been damages. This may require multiple layers of sutures. There may be muscle, tendon, or ligament damage, subcutaneous fat damage and skin. All of which will have to be stitched back together. The most important thing is to make certain that you are not allowing any dead space to remain. This dead space refers to little pockets of air and inflammatory fluid that get sealed into the wound.
When it comes to Suture Kits there are a ton of options available. Dr. Alton provides a suture kit and staple kit wound care package with an instructional DVD at DoomandBloom.net. Typically you want absorb-able sutures for deep layers. The time that the suture material takes to dissipate will vary. There is a type of suture material known as "catgut" that is made from intestines of sheep and cows (not cat). At any rate, it is a natural fiber that is good for subcutaneous fat layers and will only take a couple of weeks to dissipate. Some synthetic options include vicryl and Polydioxanone (PDS). These synthetic options will last longer but still dissolve in time. In a long term survival setting, when someone has a big tear with a complete rupture of a muscle, tendon or ligament underneath, you may be required to use a nonabsorbent material like silk or nylon. These sutures would never come out but these types of injuries require a lot of time to heal properly and a permanent material may be the only solution at that point. If the wound is big or small the instruments you need for this procedure will be the same, unless you are dealing with an obese patient, then you will need longer instruments.
The Survival Medicine Handbook is a great resource to get so you can educate yourself on how to perform sutures. You need to know where to place them. More importantly you need to know what stitch to use for each situation. Of course you need to know how to tie the recommended stitch. That's all after you decided to use a stitch vs a staple, glue or a butterfly.
There may also be times when you want to leave the wound open to heal. This is called granulation. The wound heals from the inside out and often looks granular as it does so. If you suspect that the wound may have gotten infected, you may only want to put the muscles, tendons, ligaments, and subcutaneous fat back together and leave the skin open. You can always close it if there is no sign of infection: redness, swelling, or heat in the area. While the wound is open, flush and wash it twice a day. Apply damp gauze into the wound cavity and cover with dry dressing. This is called a wet to dry dressing. Another possible tactic is to use Dakin's solution to rinse the wound. This is a very diluted bleach solution with baking soda. Different strengths are recommended for different injuries so do your home work before using it. Alternatively you could use sugar but Dr. Alton would rather see you pack it with raw honey instead. You could mix the sugar with betadine to make sugardine. This is a great healing paste that can help prevent infection. However, too much bedadine can dry a wound out and prevent healing.
If you acquire a sprain, strain or rupture, don't use it for as long as possible. Remember that sutures can tear so you will probably want to immobilize the area.When you start using it again, it will be weak from the trauma. Start out easy with light stretching and range of motion exercises. After the wound is feeling better you can start with a light weight lifting regiment. This will help build strength. Remember it will take time because the muscle has atrophied. Take it slow or you risk tearing it all over again. In some case the muscle, ligament or tendon will always be a weaker area of your body. You will need to get used to it.
A medic needs to be the safety person. You need safety gear and someone to enforce the use of hand protection, good high top boots, and eye wear. You'll have people doing jobs that they didn't do very much before, if at all. Make sure the members of your group are warming up and stretching. The medic should also be sure that water is being properly sanitized, the food is being properly prepared, waste is being properly removed and the latrines have been properly built. Ensuring that these safety measures are taken care of will prevent deaths and epidemics.
Featured Quote From Today's Chapter:
"The battle for the South is about to begin."