Originally Printed in Surfing Magazine.)
So, your surfing some Third World dream reef and you’re having the trip of your life… until that mistimed soul arch dives you into the reef and turns you into a block of swiss cheese. The cuts and bruises hurt, but that bloody, three-inch gouge hurts even more when you realize if could mean the end of your wave feast. What to do? Take a swig of moonshine, break out the bullet and prepare to fix yourself.
First things first: you gotta clean the wound. Dont brush over this step, because it could mean the difference between a sore cut on the mend or a swollen one full of pus. When you clean it, start with a good dose of bottled water, not tap water. Once its rinsed out, explore the wound a bit. Is there sand, reef or fiberglass in it? If so, every last bit needs to come out. Its gonna hurt, but its worth it. Otherwise, that wound might form an abscess, which is no good. After the first washing, its also good to do another round of cleaning. If you have beta dine, dilute it 1:1 with water and pour that on. Other substitutes: diluted bleach, vodka and lime all kill bacteria.
If you don’t have the standard nylon sutures you’d find in a First Aid kit, you’ll have to improvise. Thread works, and dental floss is very strong, although I wouldn’t recommend the mint-flavored stuff. Sterilize your needle with a flame or alcohol, then get the suture ready. The whole goal of stitching a wound is what we call “approximation”, or getting the skin as close to “pre-gash” condition as possible. You’re trying to pull it together so the two sides of the wound can heal together. Here’s the operating procedure in three easy steps:
With your fingers, pull the wound together. Locate the center of the cut, and insert the first suture by sticking the needle through the skin (.5 cm from the edge of the cut), out the wound, back through the wound on the other side and out the skin. What you’ll have is a loop of thread, as if you just ran a shoelace through the bottom two eyelets of your shoe. Pull the skin together, and tie it off with a basic double knot. Clip the excess suture. Important: do not tie it too tight – secure it just enough so that the wound is sealed. If you go too tight, it’ll kill the tissue.
Once your first suture is secured, work back toward the edge by placing a new suture halfway between the end of the cut and the closest stitch. Repeat until the wound is sealed.
Now here’s where it gets tough. The reason why doctors don’t want you to surf with stitches is that water will inevitably get in there, making it highly likely to open up again after the stitches come out. It also greatly increases the risk of infection. If you can resist temptation, keep the stitches in for the following: five days for a face gash, seven days for anything on the body and 10-14 days for a cut on the feet (for some reason, feet take forever to heal.) But if the surf is going off, you’ve followed these directions properly, and you just have to paddle back out, we understand. That’s what antibiotics are for.