Wounds
Governing: Table A-VI/4-2 'wounds, wound healing and infection', 'techniques of sewing and clamping', 'minor surgical treatment', 'dressing and bandaging'.
Assessment
| Look at | Why |
|---|---|
| Mechanism | Crush, bite, high-pressure injection and dirty objects change everything |
| Site | Face, hands, joints and over tendons need care and often specialist repair |
| Depth and length | Deep wounds may involve tendons, nerves or vessels |
| Function beyond the wound | Movement and sensation of fingers or toes; loss suggests tendon or nerve injury |
| Contamination | Soil, marine growth, rust, bilge water |
| Age of the wound | Older wounds are more likely to be infected |
Cleaning
Wear gloves. Control bleeding (MFA lesson 2.1 for tourniquets). Irrigate generously with clean water or sterile saline; a syringe gives useful pressure. Remove visible debris. Clean the surrounding skin. This step prevents more infections than any antibiotic.
Closure options
| Method | Use |
|---|---|
| Adhesive strips | Small, straight, low-tension cuts; no anaesthetic needed |
| Tissue glue (if carried) | Small, clean cuts; not over joints or in moist areas |
| Sutures | Gaping wounds under tension; requires anaesthetic and a sterile field |
| Staples (if carried) | Scalp and straight wounds |
| Clamping | Artery forceps on a visible bleeding vessel while help is sought |
The stitch itself (usually simple interrupted, knots to one side, edges just meeting, not strangled) is learned on the practical part of the course. The SCMG and TMAS will direct the material, anaesthetic and technique.
When not to close
- Bites (human or animal) and heavily contaminated wounds.
- Puncture wounds, including fish spines and sea urchins.
- Wounds more than a few hours old, unless TMAS advises.
- Wounds with suspected tendon, nerve or joint involvement.
- High-pressure injection injuries from hydraulic or fuel lines, which look small and are surgical emergencies.
Leave these open, dressed, and seek advice. Delayed closure ashore is better than an abscess at sea.
Aftercare
Record the site, length, depth, method and number of sutures. Check the wound daily. Plan removal dates with TMAS. Signs of infection: spreading redness, heat, swelling, increasing pain, pus, red streaks up the limb, fever. These need a TMAS call and may need antibiotics.
Minor surgical procedures
A-VI/4-2 includes minor surgical treatment: draining a superficial abscess, removing a splinter or fish hook, treating a subungual haematoma. Do these only within your training and, where in doubt, on telemedical advice.
CAUTION — Hands Yacht crew work with their hands: lines, winches, galley knives, stainless fittings. Any hand wound with loss of movement or feeling goes to a hand specialist; do not close it and hope.
TIP — Photographs Photograph the wound before and after closure, with a scale. MGN 623 notes photographs can support a TMAS consultation.