Introduction: DIY Sutures

About: I'm a life-hacking reuse junkie who loves to create, even if all I'm making is a mess. I love hammers and rocks and history and hand planes. I hugged trees before it was cool but can still operate a chainsaw. …

Disclaimer: the information in this instructable might come in handy sometime, but I didn’t attend medical school and don’t have the license (or the inclination, for that matter) to practice medicine (as practice it would be, indeed)outside the friendly confines of my bathroom. The general consensus is that a doctor should be consulted in matters pertaining to your health. After all, they spent more money on their formal education than we did, and they need something to show for it.

This instructable is meant for adults only. I'm a mother, and I know how pissed I'd be if some lunatic told my son how to sew himself up. I don't need your mom pissed at you or me. 

This instructable contains pictures and descriptions of an actual laceration (mine) and the skin sewing process and is therefore unsuitable for people who are squeamish about that sort of thing.

We good? Okay, let's get started, then. It's sew time.

Step 1: Get Your Supplies Together

What You’ll Need

Laceration that won't behave
Clean towel
Sterile Gauze
Antiseptic (hydrogen peroxide or bactine)
Needle (curved is what the doc uses but straight works, the smaller the better)
Alcohol (Isopropyl not drinking) and cotton ball
Lighter or matches
Thread (silk or nylon, fishing line works)
Bandage large enough to cover wound

Step 2: Take the Ibuprofen

Take the Ibuprofen. This is going to hurt a little. Take another few just for good measure. Don’t take aspirin. Thin blood is not the way to go with DIY invasive medicine. Wash your hands if you didn’t already do so.

Step 3: Prep Your Work Area

Lay out your towel on a firm flat surface. This is your dedicated work surface, so make sure you have ample space. Lay everything you need out and take a quick inventory. I didn’t do this and ended up forgetting the scissors. Oops. Take the wrapper off the bandage, the top off the antiseptic. You don’t want to have to fumble with those later.


Step 4: Sterilize Your Equipment

Grab your lighter, and put your needle in the flame. Heat it up. Don't burn yourself. Wipe your needle and line down with a cotton ball soaked with alcohol. Thread your needle and set aside. (Alternatively, you could boil your needle and line in water, but I didn't want to turn on the stove and draw attention to my antics lest they be halted unnecessarily.)

Step 5: Assess & Prep the Laceration (with Final Gut Check)

Give your wound another good look. If you've come this far, you probably think you need stitches, but you might not. Would it stay together with butterfly bandages? Superglue? If so, go that route. I've glued on a few occasions with great results. In this instance, I had already tried butterflies, which failed immediately. Since the laceration was completely through the skin and a few inches long, I felt superglue wouldn't be effective.

If the area around your laceration is quite swollen (mine was), ice it for a few. You have a couple of minutes to kill before the ibuprofen starts working anyway. This will help the swelling go down and give you a little added numbing benefit. Not near enough, but we'll pretend it helps. Don't apply the ice directly to the wound. You don't want to soften too much skin or you'll have a helluva time keeping your line in it without it cutting through. Thoroughly clean your cut with an antiseptic like bactine or hydrogen peroxide. If you feel like throwing up after the cleaning of the wound, go take care of that before proceeding. I did.

Gut check time. Take a deep breath. If you feel unsure of your ability to stitch yourself, abort mission. It's okay. Most people don't do this sort of thing, anyway. Take a good look at your cut again. Still think it could benefit from stitching and still don't want to go to the hospital? Yes? Still with me? Okay, sport, grab your needle. It' sew time!

Step 6: Sew It Up

 Ever been sewn up by a medical professional? Usually they take a curved needle, run it from the outside through the entire layer of skin, then across the laceration back through the other side,bottom to top and out. Then they tie off each stitch with a square knot. This is called a simple interrupted suture. The benefit of this type of suture is its strength (since it is anchored on both sides in the entire layer of skin, which is quite thick) and its independence from other sutures. Should one suture fail, the rest will remain in their places to keep the wound together. It didn't take long to realize this method was not going to work in my situation. The first obstacle was my straight needle. Once I got it all the way through my skin, it was kind of a dead end. Turning the corner to cross the wound required a lot of strain on an already injured part of my body, and also got it to bleeding again. Compounding the problem was the fact that the laceration being stitched was on my hand. That means that I only had one hand to use, and it's job was stitching. When I tried to go back up through the other side, my skin provided enough resistance to the needle that it just pushed the skin away and the cut open wide instead of nicely piercing the skin so I could complete the stitch. I ended up holding the skin in place with 2 fingers and pushing the needle throughwith my thumb. Frankly, after one pass in this manner, I felt a little like passing out. Okay, maybe more than a little. So I modified the stitch and the rest was cake (compared to the first stitch, at least).

Instead of going all the way through the skin at a steep angle, I went only halfway through at a much gentler slope. After the needle exited at the center of the cut, instead of entering back through in the same direction and going bottom to top, I changed directions and went top to bottom again. The direction of the stitch was always toward the cut, which meant I was always pushing the two pieces of skin toward each other instead of pulling one away during the stitch.

Doing it this way is much less traumatic, but makes interrupted suturing impractical if not impossible. Instead, do a series of running stitches in this fashion. I did mine in 2 sections. (Note: Don't strain the stitched area any more than you have to, either while stitching or during your recovery period. The drawback to uninterrupted stitches is that if part of the stitch fails (ie, pulls out), the whole stitch slacks)

Starting at the midpoint where the cut is the widest, stitch to the end of the cut, alternating sides. Make sure and leave yourself a good sized tail on your first stitch so a) it doesn't pull through and b) you have something to tie onto when you start the second segment going the opposite direction.

As you stitch, the goal is to pull the line snug enough so your skin approximates its original position. If your skin is puckering or rolling at stitch points, you either are pulling the stitches too tight or not stitching deep enough to get a good anchor.
When you reach the outer edge of the laceration, loop back to the stitch prior and knot. Cut the excess line from that end only (you should still have your tail in the middle). If you don't have enough thread left on your needle to complete this running stitch segment in the opposite direction, reload now.

Now go back to the midpoint of the laceration, tie the second length of thread to the first tail, and stitch in the same fashion as before, in the opposite direction, to the other end of the cut.

When you reach the end, again loop around the stitch prior and knot. Exhale.

You made it.  Nice stitching!

Step 7: Cover It Up

 As much as you want to admire your handiwork at this point, you're going to need to get it protected. Give it another shot of antiseptic and put your bandage on.

Step 8: Watch It Close

When you get a deep cut, you always run the risk of infection. It doesn't matter if you sewed it up or your doctor did. Keep it clean, keep it protected, and watch it closely. Change the bandage a few times a day. If at some point it starts being redder, hotter, or uglier than it was when you buttoned it up, don't wait until it kills you. Take further action. Infection is serious business. 

This is my hand post-healing. The scar will stick around, but I just consider it a reminder to be cautious with sharp objects.

Step 9: Update

It's been a few years and a small city's worth of views, so I thought I'd give one final update. I'm still alive and the scar has faded substantially. I still hurt myself all the damn time, but I'd like to think it's less frequent and I'm better prepared to handle it. I have health insurance now, which is awesome, but I still do much of my medicine at home. Take care of yourselves!