# Israeli Wound Closure



## irishboxer384 (Oct 18, 2014)

Pretty nifty looking

http://agilitegear.com/blogs/news/1...edical-device-zipped-up-combat-wounds-in-gaza


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## Underoath87 (Oct 18, 2014)

Ok, so when you watch the video you'll see that there is no actual zipper, just the zip-tie things.  I suppose it would be good for long, fairly shallow flesh lacerations.


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## irishboxer384 (Oct 18, 2014)

Like this one:


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## Underoath87 (Oct 18, 2014)

Wow. Yeah, that would work.


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## OnceAnEMT (Oct 18, 2014)

Underoath87 said:


> Ok, so when you watch the video you'll see that there is no actual zipper, just the zip-tie things.  I suppose it would be good for long, fairly shallow flesh lacerations.



I was so damn confused by the zipper, then eventually realized it was just part of the ad. 

Interesting concept. Keeping in mind it is more for healing than for wound management/bleeding control, we probably wouldn't come across one in the field. Curious how well the adhesive holds up.


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## irishboxer384 (Oct 19, 2014)

Yea I'd also be interested in the adhesive strength, looks pretty good for a remote setting though. Im gonna try and get one I think for work.


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## redundantbassist (Oct 20, 2014)

Its a good idea, but it looks like it has limited applications. If you have a laceration that is severe enough that it would need to be closed, it would be stupid to waste time fumbling around with a zip tie thing, when you could just hold pressure and transport to the hospital.


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## OnceAnEMT (Oct 20, 2014)

redundantbassist said:


> Its a good idea, but it looks like it has limited applications. If you have a laceration that is severe enough that it would need to be closed, it would be stupid to waste time fumbling around with a zip tie thing, when you could just hold pressure and transport to the hospital.



I think the product is intended for hospital application, ideally to replace sutures. Evidence has shown that adhesive-closures heal more quickly and with less scarring when compared to sutures. That said, also keep in mind that ERPs will generally not suture a wound that has been steri-stripped. I am sure the same rule would apply in this case as well, if the product shows to be effective as steri-strips.


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## irishboxer384 (Oct 20, 2014)

For remote settings or military uses where air support/casualty extraction is not coming anytime soon... it looks like it might work or at least be a quick alternative. The photo I put up before was a friend who peeked a little too far around a compound corner in Afghan and got hit by 7.62, due to lack of air support he had to continue the patrol for another 4 hours in that state, something like this might have come in useful in a tactical setting. I've never seen/heard of anyone using this design though so would be interesting to see how it pans out in field use.


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## redundantbassist (Oct 20, 2014)

irishboxer384 said:


> For remote settings or military uses where air support/casualty extraction is not coming anytime soon... it looks like it might work or at least be a quick alternative. The photo I put up before was a friend who peeked a little too far around a compound corner in Afghan and got hit by 7.62, due to lack of air support he had to continue the patrol for another 4 hours in that state, something like this might have come in useful in a tactical setting. I've never seen/heard of anyone using this design though so would be interesting to see how it pans out in field use.


I'm no 68w but I guess I'll take a shot at this. In the field you would want to stop severe hemorrhaging, not close up a wound. Combat medics follow the TCCC MARCH acronym (Massive hemorrhage, Airway, Respirations, Circulation, Head injury and hypothermia) when treating trauma. They do this by applying a tourniquet, packing the wound with Kling or quikclot, and applying a pressure dressing. After the bleeding is stopped, all the packing material and bandaging is left in place until the soldier gets to the OR. This device does not achieve hemostasis, nor is it easily applied in the field (ever try to stick something to sweaty, bloody skin?) therefore it is ultimately useless in the field. Like grimes said, it would be a good idea in a hospital setting, after the wound was cleaned, but It would be stupid to give to EMS or Combat Medics.


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## irishboxer384 (Oct 21, 2014)

redundantbassist said:


> I'm no 68w but I guess I'll take a shot at this. In the field you would want to stop severe hemorrhaging, not close up a wound. Combat medics follow the TCCC MARCH acronym (Massive hemorrhage, Airway, Respirations, Circulation, Head injury and hypothermia) when treating trauma. They do this by applying a tourniquet, packing the wound with Kling or quikclot, and applying a pressure dressing. After the bleeding is stopped, all the packing material and bandaging is left in place until the soldier gets to the OR. This device does not achieve hemostasis, nor is it easily applied in the field (ever try to stick something to sweaty, bloody skin?) therefore it is ultimately useless in the field. Like grimes said, it would be a good idea in a hospital setting, after the wound was cleaned, but It would be stupid to give to EMS or Combat Medics.



It depends on your definition of 'in the field'. You're assuming that the soldier/patient would be able to be extracted- there are times in the military and remote setting where you can spend days, rather than hours without extraction depending on the nature of the job. So your 'hospital' is limited to what you may have in the field. My current role I am a 3 day drive from what could even be considered a hospital and even then I wouldn't trust it. Rather than manual suturing which could take considerable time, or leaving the wound open, covered and keeping clean...the Israeli option looks like it has potential to at least close the wound quickly after cleaning. The adhesive quality of the device is in question, but then again we have been using asherman's chest seals for years.


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## redundantbassist (Oct 21, 2014)

irishboxer384 said:


> It depends on your definition of 'in the field'. You're assuming that the soldier/patient would be able to be extracted- there are times in the military and remote setting where you can spend days, rather than hours without extraction depending on the nature of the job. So your 'hospital' is limited to what you may have in the field. My current role I am a 3 day drive from what could even be considered a hospital and even then I wouldn't trust it. Rather than manual suturing which could take considerable time, or leaving the wound open, covered and keeping clean...the Israeli option looks like it has potential to at least close the wound quickly after cleaning. The adhesive quality of the device is in question, but then again we have been using asherman's chest seals for years.


The issue I see with using this device for a GSW is that applying it involves removing the dressing you applied to the wound, and in the process tearing away any coagulated blood. (ouch) Remember, as either civilian or military prehospital providers our job is not to close a wound. Our job is to stabilize our patient and that would mean stop the hemorrhaging. Even for a long period of time, I would prefer a patient that was treated with a sterile dressing rather than risk restarting the bleeding and introducing even more bacteria into the wound site.


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## irishboxer384 (Oct 22, 2014)

Are you/have you been employed in a remote area before, because you seem to have a misconception about what medical provision is covered in remote areas/warzones? Treatment in remote areas isn't limited to pre-hospital care for the reasons I've previously mentioned. 

"Our job is to stabilize our patient and that would mean stop the hemorrhaging" is a very basic idea of what medical care consists of in the remote setting....


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## redundantbassist (Oct 22, 2014)

> Are you/have you been employed in a remote area before, because you seem to have a misconception about what medical provision is covered in remote areas/warzones?


As I have previously stated, I'm no 68w. However, I fail to understand how this device would significantly improve the condition of a patient suffering a GSW. I have researched the TCCC guidelines, and I've yet to find a source that advocates closing a wound with a device like that. Perhaps you have more training than I do and you could enlighten me?



> Treatment in remote areas isn't limited to pre-hospital care for the reasons I've previously mentioned.


Now, this statement does not make sense.  All emergency care, regardless of how basic or advanced, that is conducted before the pt reaches the hospital is pre-hospital care. 

So, all along I've been trying to ask you is the devices purpose in a prehospital environment. It doesn't do much of anything to stop hemorrhaging, and traps bacteria in the wound. So, why would it be of any use in the field?


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## irishboxer384 (Oct 22, 2014)

redundantbassist said:


> As I have previously stated, I'm no 68w. However, I fail to understand how this device would significantly improve the condition of a patient suffering a GSW. I have researched the TCCC guidelines, and I've yet to find a source that advocates closing a wound with a device like that. Perhaps you have more training than I do and you could enlighten me?
> 
> 
> Now, this statement does not make sense.  All emergency care, regardless of how basic or advanced, that is conducted before the pt reaches the hospital is pre-hospital care.
> ...



No offence, but I'm not here to explain to you the differences in medical care and protocols used by remote medic companies and PMCs for lovely places such as Syria, Sudan, Somalia, Iraq and Afghan etc when a casualty evacuation cannot be conducted. 

Personally, I don't comment on medical systems for which I have no knowledge about...I put link up for the device  as I thought it might be interesting for people who DO or HAVE work in extremely remote areas etc...


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## redundantbassist (Oct 22, 2014)

irishboxer384 said:


> No offence, but I'm not here to explain to you the differences in medical care and protocols used by remote medic companies and PMCs for lovely places such as Syria, Sudan, Somalia, Iraq and Afghan etc when a casualty evacuation cannot be conducted.
> 
> Personally, I don't comment on medical systems for which I have no knowledge about...I put link up for the device  as I thought it might be interesting for people who DO or HAVE work in extremely remote areas etc...


Ok my friend, it was nice to discuss it with you.


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## irishboxer384 (Oct 22, 2014)

No worries mate take it easy


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## Joey DeMartino (Dec 26, 2014)

Looks to me like this addition to our tool boxes only increases the likelihood of gaining the edge on a number of injury scenarios. Most field personnel could be trained on the parameters of use in a short time.
   Blood and sweat issues probably wouldn't be much of a concern given the fact that it is a quick setting and extremely durable bonding agent. It's temporary design allows the receiving unit the option of re-opening the wound if further intervention is necessary  
   Clean one side of the wound and set, repeat the process on the opposite side and you're pretty much done. Worse case scenario, other than arterial compromise, temporary restriction of circulation, set , and evac (if possible).
    Given the fact that makeshift duct tape butterflies have worked for me-albeit temporarily- and most field folks I know have a hard enough time sewing a button on a shirt, sutures are out.  Thanks for the post- good fuel for thought.


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## Joey DeMartino (Dec 26, 2014)

And as far as  GSWs (which- for me- are now chainsaw, hand tool and environmental in nature)- as you know- there are a myriad of types and conditions relating to them. Sure it may not work for all situations but it I know there are enough possibilities (grazing injuries to the extremities, and some superficial chest and torso wounds) that the device would be a beneficial and best choice tool to use over other options that are now archaic standard issue trash.


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## redundantbassist (Jan 17, 2015)

Joey DeMartino said:


> And as far as  GSWs (which- for me- are now chainsaw, hand tool and environmental in nature)- as you know- there are a myriad of types and conditions relating to them. Sure it may not work for all situations but it I know there are enough possibilities (grazing injuries to the extremities, and some superficial chest and torso wounds) that the device would be a beneficial and best choice tool to use over other options that are now archaic standard issue trash.


Wait... A gunshot wound caused by a chainsaw? Where the hell are you getting your chainsaws?


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## Joey DeMartino (Jan 17, 2015)

Stihl and Wesson-of course.
 Kenny would be very disappointed in you my friend.   The type of closure offered by this device was not meant for punctures-obviously- but for exit wounds (with closable potential). , lacerations,  avulsions, amputations, etc. as my comments illustrated.

  I've read more on the this type of closure and I'm at a point that arguing for or against it is still open although it doesn't just seem to be a device or concept that should be scoffed  at by anyone but the willingly ignorant and cartoon characters (of which you are obviously neither). 

 I came from a time when tourniquets were deemed to dangerous to use based on junk science. And now... SOP.     I've seen this time and time again.  Read a little more about them, add the typical progression and evolution of new products and them let me know what you think. Just don't let your wound get caught in the zipper. "SARCASM-JOKE"

  Let me know when you want to come on over.  Bring your saw and we'll do some target shooting.  "SARCASM-JOKE"  I don't let anyone not skilled in preventive saw hazard mitigation shoot my saw.  You should know that by now.....


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