Stitches should be taken in any wound that is deep or gaping and in which the the edges of the wound seem unlikely to stay together without some sort of assistance. Stitches help provide a barrier to prevent infection of the underlying tissues. Care should be taken to draw the edges of the wound together neatly, so there is no puckering of the surrounding skin and to take as few stitches as possible, so the scar is as small as possible. A stitched wound should be kept moist, to further avoid scarring. Stitches should be removed by a Dragonhealer approximately a sevenday after insertion, but this may be adjusted on a case-by-case basis. In general, when a Dragon begins to complain of itching, sufficient healing has taken place to allow the removal of the stitches. Applying Stitches to a Wound:
- Oil your hands so that you can perform the dexterous movements required.
- Follow the normal procedure for washing up and cleaning a wound.
- Apply a thin coat of Numbweed, using just enough to deaden the area.
- Caution the Rider not to look at what you're doing. Many people are distressed by the sight of stitches being put into hide.
- Using a sterile Needlethorn, or one of the steel needles produced by the Smithcraft, and treated thread, usually coated with wax, make small neat stitches.
- Push the needle through the hide, towards the wound, then through the other side of the wound, from the wound and out, with the same piece of thread.
- Loop one end twice over the other and tighten, this will form a knot.
- Clip the excess and start the next stitch.
- Continue until the edges of the wound is drawn together, but not tightly. Tight stitches will cause puckering of the surrounding hide, and may become impossible to remove. Always make as few stitches as possible but make sure the wound does not gape. You need this to be a barrier to infection. Leave a small gap of no more than 2.5cm to assist in preventing infection: if you close the wound completely some germs reproduce even quicker!
- Apply a thicker coat of Numbweed to the wound.
- Explain the signs of infection to the Rider and warn them to see a Dragonhealer if they notice any of them. You should check on them periodically.
- In a sevenday remove the stitches.
Removing Stitches from a Wound:
- Wash up and cleanse the area as usual.
- Apply a light coat of Numbweed.
- Ask the Rider to look away, so they will not be upset by the sight of you withdrawing the threads from their lifemates hide.
- Clip the threads with scissors, or cut them with a sharp knife, being careful not to cut the hide.
- Using small forceps, remove each of the threads from the hide.
- Apply a light coat of Numbweed over the punctures left by the threads to seal them.
Most Dragonhealers utilize one method of stitching which can cause substantial scarring of the tissue, leaving the wound unsightly. The removal can be unpleasant for the Dragon as scar tissue can form around the knots. However, some higher qualified Dragonhealers now utilize another technique (it being harder to learn). This method consists of starting at one end and not at any point tying off. This means there are no knots for scar tissue to form around and thus, when removing the stitches by simply cutting one end and pulling on the other, causes less pain to the patients. Wounds are less puckered with these 'running' stitches than previously observed with regular stitches.