Ray Mears shows us how to bake bread in the outdoors over a campfire

Though there is no shortage of big-budget, Hollywood entertainment available through every outlet imaginable these days, it has long been difficult for conservatives to find films that really speak to their life ways and values, or at the very least, films from which conservatives can derive any message or meaning aside from “don’t act like the people you’ve seen.”

But as it turns out there are more than a few Hollywood movies that have made their way through the gauntlet of baked-in, bone-deep leftist ideology that has so infested Hollywood for decades.

By accident, design or through clever marketing and trickery there are more than a few movies with decidedly conservative messages, or movies with stories that at the very least will appeal to conservatives on principle.

Today we bring you a list of 15 conservative movies you should definitely watch, spanning all genres from action and drama to parody and thriller. No matter what sort of movies you like, as long as you can appreciate a good film you are sure to find a movie on this list that you will enjoy.

The Book of Eli

The Book of Eli, released in 2010, is a post-apocalyptic tale of a man travelling through the dystopian remains of the western United States. The man, Eli, as portrayed by the always entertaining Denzel Washington has in his possession a book that he is doggedly attempting to deliver to the West coast.

It is this book that the petty tyrant of a town he travels through, Carnegie, played in spectacularly fashion by the inimitable Gary Oldman, will stop at nothing to get.

Along the way Eli encounters ceaseless depravity, ruin and the crushing weight of existential futility in America that was, and though he is beset by bandits, brigands and a lack of resources he not only refuses to give up his quest but maintains his humanity, dignity and virtue in a wasted nation. Sort of like today…

The ending might be a twist you can see coming a mile away, but the Book of Eli can show us how important it is to stay the course, even when it is anything but certain, and that your principles should persist even when the whole world goes to hell.

No Country for Old Men

A 2007 adaptation of Cormac McCarthy’s riveting novel of the same name, this film by the Cohen Brothers is a tale about a man who gets in over his head after stumbling across the site of a massive Mexican cartel drug deal gone bad in the middle of the desert during his hunting foray.

The man, Llewellyn Moss,soon finds himself a marked and hunted man as the cartels bring in a remorseless and seemingly unstoppable hitter, Anton Chigurh.

Though the cat and mouse chase is absolutely riveting and full of several unexpected twists and turns, the real protagonist of the movie is not Moss, but instead an aging sheriff on the trail of both men, Ed Tom Bell portrayed by Tommy Lee Jones.

Sheriff Bell is a man who is nearing the end of his career, and is increasingly incapable of dealing with the escalating violence, viciousness and remorselessness that is embroiling the region. The real story is his coming to grips with the events that we witness on screen.

A mesmerizing film by some of the best living filmmakers and adapted from a harrowing and darkly beautiful novel, No Country for Old Men is simultaneously a film about choice and consequences, elemental forces that cannot be contained and sticking to your guns even when it might mean your death.

The Grey

The Grey is a classic tale of disaster, adversity, survival and introspection, that sees us following a crew of Alaskan oilfield workers who find themselves marooned and injured, and the harsh Alaskan Wilderness after the plane they are riding in crashes.

Led by John Ottway as portrayed by Liam Neeson, the men are constantly harried by wolves and are forced to set their differences aside if they want to survive. Increasingly difficult decisions are made as the men claw their way through the harsh wilderness in an attempt to keep their lives.

Although the film sounds like any standard issue yarn of survival in an unforgiving wilderness, it is also a poignant tale about a man grappling with nihilism in the wake of his wife’s death. Ottway initially has a very dim appraisal of his coworkers, but after their everyday circumstances are set aside some better qualities emerge while others “better” qualities are shown to be just an act.

Thrilling and with a surprising philosophical bent The Grey sets itself apart with tight direction, an excellent leading man and gorgeous landscape shots. The movie is an ode to persistence in the face of seemingly unbeatable odds.

United 93

On September 11th, 2001, everything changed for America and the world. Put under attack by hijacked commercial airliners, a nation collectively held its breath as it stared into an uncertain future.

One of those airliners, United Airlines Flight 93, was diverted from its intended, terrible purpose after passengers rallied and tried to retake the aircraft from the hijackers.

This film is a real-time account in docu-drama style of the events that transpired on board the aircraft and elsewhere among air traffic control personnel. It is a chilling, riveting, grimm and ultimately inspiring reminder about civic duty and taking responsibility for your circumstances no matter what they might be.

Though we have a surprisingly clear picture of what transpired on the aircraft that day, some liberties are taken with gaps in the information in order to tell a coherent story. Nonetheless, United 93 is required viewing for any red-blooded American.

Starship Troopers

Though it deviates pretty radically from the beloved Robert A. Heinlein novel of the same name, Starship Troopers is nonetheless a pretty good sci-fi action yarn at face value, but the real sustenance of the movie is it’s biting and deeply satirical lampooning of ultra-nationalist sentiment.

The story follows a group of high school students (you read that right) who are joining up in federal military service in order to secure themselves citizenship rights, as compared to remaining merely civilians with less status and fewer civic privileges.

Naturally, a planet of bugs lurking elsewhere in the galaxy (somehow) launch a meteor that strikes and obliterates their hometown.

Melodrama ensues with dear John letters, massive failures in training, rising to the occasion, redemption, loss, heroism and woven throughout a deeply satirical piss-take aimed at the military industrial complex.

It is a fun, if corny, romp on its surface, but the movie also serves as a cautionary tale and a self-deprecating joke that the most fervently patriotic of us can enjoy, and would do well to heed.

Red Dawn

More than any other, this film codified the half fear half fantasy of many preppers, especially Cold War-era youngsters. Red Dawn tells a story that sounds almost laughable today: Russians along with their Cuban and Nicaraguan allies invade and occupy the continental United States.

The setting is a somewhat nebulous World War III scenario in an alternate timeline: NATO has been disbanded. The United States, already geographically isolated, is strategically isolated and further backed into a corner after Mexico decides to go socialist.

A group of teenagers and young adults have Russian paratroopers airdropping into their town in the middle of the day. Naturally, they band together, desperately try to stay alive and eventually metamorphize into a resistance movement using American and stolen Soviet equipment: the Wolverines.

Director John Milius knows how to shoot his films, and this one is no exception. The film is tense, frightening and exciting, but pulls no punches with its depictions of what life would be like in an occupied America, especially one where outmanned and outgunned civilians strive against all odds to overthrow or at least degrade their numerically and technologically superior occupiers.

Man on Fire (2004)

This adaptation, directed by Tony Scott and sourced from the novel of the same name Man on Fire tells the tale of John W. Creasy, a former Force Reconnaissance Marine and CIA special activities agent who’s trying to get back on the horse after nearly ruining his life with alcoholism, guilt and a botched suicide attempt. An American friend of Creasy who runs a security firm in Mexico City gets him a gig protecting a wealthy automaker’s young daughter, Pita.

Initially reluctant, Creasy begins to rediscover his better qualities and his purpose through the job, but things go pear-shaped when the young Pita is kidnapped.

Consumed with guilt and a cold fury, Creasy begins a roaring rampage of revenge to eliminate everyone involved in the kidnapping and to get answers in an increasingly murky and harrowing investigation regarding who put who up to taking his young charge.

Anchored by excellent cinematography and a stellar cast, Man on Fire is about loss, despair, and redeeming oneself even after you are hanging over the edge of oblivion. Sometimes sacrifice is the only penance that can be left to you.

Braveheart

Braveheart is a film that hardly needs any introduction for most of our readers, but for the younger set out there who somehow have managed to miss this epic film, you should correct that post haste.

Directed by and starring Mel Gibson, Braveheart tells an embellished and only reasonably accurate account of William Wallace, late 13th century Scottish warrior, as he struggles to free Scotland from the oppressive rule of king Edward I of England.

Throughout the rollicking events of the film William Wallace must deal with the loss of his love, the betrayal and seeming betrayal of countrymen who care more about treasure than nation, and the intrigue of royal politicking. Gathering and leading an army by his side that is composed of often quarrelsome rival clans proves to be an incredible challenge in its own right.

A blockbuster smash hit upon release that has only grown more and more fondly received as the years have gone on, Braveheart is a quintessential story about love for country, loss, the challenges of leadership, bravery in the face of overwhelming odds and the importance of tribe, of having people on your side; your people. If you are a history buff the account of Wallace’s life and actions in the film is liable to make you grind your teeth, but table your gripes for a few hours and enjoy this endlessly quotable movie! Freeeeeee-dommmmmm!

Unforgiven

Another film whose director is also the leading man, Unforgiven is an epic, gritty and poignant western that also serves as a no-holds-barred takedown of the entire genre.

This is especially poetic because this was the final true western genre film that Clint Eastwood starred in, a genre that he helped boost to global recognition and fanfare.

This is not the typical western of yesteryear, one where the good guys wear white hats and the bad guys wear black: all we have is gray, gray and grayer yet morality in a tale of redemption, revenge and learning too late about one’s limitations.

Eastwoods stars as William Munny, a retired outlaw and gunslinger who is recruited to take revenge on some cowboys who grievously maimed a prostitute.

Though Munny is a widower and a profoundly repentant man raising two children on a failing farm, he isn’t doing it for charity or to make amends: he is in it for the payout, and has been recruited by a young gunslinger to claim and split the bounty put on the hateful cowboys by the victimized prostitute’s coworkers.

Munny very literally picks up his guns again, recruits another retired accomplice and sets off to do the job.

The gunfights crackle, and all the typical western tropes are here, but they are almost always shockingly grim and realistic portrayals of how the events so often depicted would really go down.

Tired, old gunslingers are, well, tired, old and slow, surviving by luck if they survive at all. Young pretenders to the title find out that there is nothing glamorous whatsoever about gunfighting and living that lifestyle.

Unforgiven reminds us that living by the sword very often means you will die by the sword, and that the real stuff of survival on the sharp end is anything but fun, fantastic and exciting.

Dirty Harry

Another Clint Eastwood mega-hit, Dirty Harry is arguably his most iconic role and the one that shot him to superstardom. A gritty neo-noir thriller, Dirty Harry follows the eponymous “Dirty” Harry Callahan as a San Francisco Police Department inspector hot on the trail of a psychotic killer, a sniper who chooses his victim’s seemingly at random unless he is paid a hefty ransom.

Dirty Harry Callahan is such an iconic antihero because we are all sympathetic to his plight: A man of action, not introspection or nicety, who is ready, willing and able to get the job done for the right reasons, no matter the cost, but also a man who is mired in an increasingly functionary bureaucracy that hinders him at every turn.

Frustrated to the bitter end by a legal system that seems to serve criminal more than victim, Callahan begins following the killer on his own time after he gets off of charges on a technicality.

The final, climactic showdown against the irredeemably evil psychopath is immensely satisfying, and Dirty Harry literally and figuratively throws down his badge in the end. Anyone who has ever been fed up with the system and its rules that get in the way of doing the right thing will cheer through the entirety of Dirty Harry.

Black Hawk Down

Ridley Scott’s Blockbuster adaptation of the nonfiction book of the same name written by journalist Mark Bowden, Black Hawk Down is an account of the disastrous 1993 U.S. military raid in Mogadishu, Somalia.

In response to the local warlord’s seizure of Red Cross aid and food shipments, the U.S. military besides to put an end to his tyranny by launching a raid to capture two of his top lieutenants after U.N. peacekeeping forces prove to be completely neutered and not up to the task, as always.

The raid begins smoothly enough, but after a U.S. UH-60 Blackhawk helicopter is shot down by RPG fire things snowball and rapidly go from bad to worse.

Pilots are captured, roadblocks are set and what follows is the Battle of Mogadishu, a day-long bloodbath that saw nearly two dozen US servicemen killed and over 1,000 Somali irregular and militiamen casualties.

The film is brutal, and a bracing look at warfare. Heroism and valor are on full display, but the film pulls no punches with the gory reality of what happens when a top-tier military force is pitted against a seemingly numberless swarm of poorly trained and ill-equipped fighters.

It is easy for viewers to truly feel the chaos and confusion attendant with full-scale modern warfare in a built up area.

300

The bombastic, gory and thrilling big screen adaptation of Frank Miller’s comic of the same name, 300 was a phenomenon when it was first released in theaters way back in 2007. The story tells a fictional, highly stylized, even fantastical, version of the entirely real historical Battle of Thermopylae during the Persian Wars.

Noble and ferocious Spartan King Leonidas leads a tiny force of 300 spartans, his personal “bodyguard”, into battle against the absolutely immense Persian army led by the “God-King” Xerxes.

Myth and prognostication prevent the deployment of the full might of the Spartan army, a roadblock further cemented by meddling, ambitious and traitorous Spartan senators.

A classic last stand in every sense of the word, 300 chronicles the unbelievable initial victories of the tiny band of Spartans in the face of a numerically superior foe, only to see them slowly whittled down and inevitably enveloped before being killed to a man.

Their heroic, unflinching sacrifice in the face of their foe, according to Spartan law, is the spark that galvanizes the rest of Sparta and eventually all of Greece against the invading horde.

The Thin Red Line

Another war epic, both written and directed by virtuoso filmmaker Terence Malick, The Thin Red Line shows us a slightly fictionalized version of the battle of Mount Austen, one battle among many in the grueling Guadalcanal campaign during World War II.

Comprised of a surprising amount of introspection, it portrays the point of view of various soldiers in C Company, 1st Battalion, 27th Infantry Regiment, 25th Infantry Division.

Compared to many other war films, The Thin Red Line is particularly philosophical, and explores in detail the internal motivations, and innermost thoughts, of the men it portrays.

From lowly privates who just want to escape the meaninglessness, drudgery and horror of war all the way up through power hungry senior officers who are enamored of the glory they think is inherent to the whole affair.

The film is notable for presenting such a nuanced, human and multifaceted view of war and its effects on the people who fight it, and not for nothing the entire film is set against a backdrop of jaw-droppingly gorgeous cinematography and landscape shots that are punctuated by the bloody exclamation point of war itself.

No Safe Spaces

The only legitimate documentary on this list, No Safe Spaces, released in 2019, chronicles the increasingly hostile and censorious climate that has infested seemingly every American University and place of learning throughout our country.

Directed by Justin Folk, the film features Adam Carolla and Dennis Prager interviewing various faculty and college students at different universities about such topics as freedom of speech, the right or lack of right to be exposed to dissenting opinions, political censorship and the increasingly prevalent attitude of “canceling” anyone who does not tow the line with the prevailing corporate and government sponsored attitudes of the era.

Chronicled in the film are the challenges experienced by Dr. Jordan Peterson in Canada, the Brett Weinstein incident at Evergreen State College’s day of absence and the Lindsay Shepard controversy with more besides.

Notable is that the filmmakers purposely included left-leaning opinions on the matter in the film with many of them arguing that modern day ultra-leftists getting their way on these topics today will result in the pendulum swinging back to smash in their faces sometime in the future.

Gran Torino

Clint Eastwood racks up another double entry on this list with his film Gran Torino, the story of a bitter and increasingly hostile (to the outside world) veteran of the Korean war who has recently become a widower. The tale is one that is likely to be very close to most of us, as Eastwood could be any one of a number of people that we all know or used to know.

Walt Kowalski, portrayed by Eastwood, is losing touch with the world: his family is disinterested, his sons don’t get along with him and his grandchildren think he might as well not exist at all. His racist tendencies are flaring hard as the world continues to move on and leave him behind, and even his once whiter than porcelain neighborhood is now rapidly diversifying with a massive influx of Southeast Asian immigrants.

But, sometimes people surprise you, and as Kowalski learns that he indeed has more in common with the principles and lifeways of his Asian neighbors that he thinks he hates than he does with his own family, he takes their young son under his wing after saving him from his gangbanger cousins.

Kowalski endeavors to teach the young man a few things he knows about life and in the end gifts him his most prized possession, his mint condition Gran Torino, after ridding the town of a dangerous scourge through an act of selfless bravery.

Conclusion

There you have it. A list of 15 movies that no film-loving conservative should go without seeing. There is something for everyone on this list, and within each film are observations, messages and themes that are likely to resonate with the values that conservatives hold so dearly. Get your list out and clear your weekend and make sure you check out each of these films.

P.S. We’ve made a list of 20 survival movies you should watch here.

Making a Resin Candle that burned for almost 1 Hour. Coniferous Tree Resin, Birch Bark and a short stick

Are you ready to live an MRE life if you absolutely have to? Here’s what you need to know about MREs.

The Meal, Ready-to-Eat (MRE) was created by the United States Department of Defense in 1981 to replace canned MCI (Meal, Combat, Individual Rations).

MREs come in lightweight packaging that can withstand severe changes in weather and have a long shelf-life. They are considered to be a complete meal in a bag, making them a popular choice for Preppers looking to stock their pantries, Get Home Bags, and Bug Out Bags.

MREs have been consistently updated based on service members’ needs and preferences as well as advances in technology. Current MREs come with a Flameless Ration Heater (FRH) that allows enjoyment of a hot meal without the need for fire. This makes it pretty appealing to many Preppers planning for years of off-grid living.

Source of Total Nutrition

Each MRE contains 1,200 calories if consumed in full and can be eaten for 21 days straight before nutritional deficiencies occur. There are currently 24 entrees and 150 additional items available in MREs.

MRE meals are specifically recommended for people engaging in an active lifestyle, as they contain high fat and salt contents that are not ideal for sedentary lifestyles.

MREs also lack dietary fiber, which can lead to constipation.

Inside each pack you’ll find:

Main course (often referred to as “the main”)
Side dish
Dessert or snack (typically commercial candy, fortified pastry, first strike bar, or Soldier Fuel Bar)
Crackers or bread
Spread of cheese, peanut butter, or jelly
Powdered beverage mix: fruit-flavored drink, cocoa, instant coffee or tea, sports drink, or dairy shake
Utensils (occasionally it includes a full set – spoon, fork, and knife, but usually just a plastic spoon)
Flameless ration heater (FRH)
Beverage mixing bag
Accessory pack:
Xylitol chewing gum
Water-resistant matchbook
Napkin/toilet paper
Moist towelette
Seasonings, including salt, pepper, sugar, creamer, and/or Tabasco sauce
Freeze-dried coffee powder

Built to Withstand the Elements

The packaging of MREs is what makes them really special. They can withstand freefalls from 98 ft.

They have a minimum shelf life of three and a half years at 81°F, nine months at 100°F, and short durations from −60°F – 120°F. New forms of packaging are being explored, using zein to replace the foil, which can be easily punctured, conducts heat, and is reflective.

Not Winning Flavor Awards

While it may sound like MREs are the perfect food to line your bunker with, they have one major drawback – they are far from delicious.

While they will meet your basic nutritional needs and sustain you as you fight to survive, you probably won’t be looking forward to dinner each night. On a scale of 1-10, expect your MREs to come in somewhere around a 4-5.

If you’re looking for specialty MREs, you can find vegetarian, Kosher/Halal, and shellfish-free options.

Pricey Given the Options

They are pricier since MREs are not always a meal of choice when you have other options to choose from. They typically sell from various companies for $6-12/piece.

On the plus side, you can purchase them in bulk for much less. You can purchase an entire year’s supply of MREs for $3,700-7,500, allowing you to check one big thing off of your Prepper’s list.

MREs may not be the most desirable meal that you’ll crave, but they can last up to five years and contain all of the nutrition you need, making them a Prepper favorite. Learning to live the MRE life when you need it will definitely come in handy.

Where can you buy MREs?

Real Military MREs can be often be bought on ebay, craigslist and other sites. But Commercial for the public mres made and sold by the same manufacturers, just for the public are available at select high end Survival & Prepping sites like Survival Warehouse.  Buy MREs here

Have you eaten an MRE before? Let us know your thoughts in the comments section!

Traumatic injuries occur in the tens of millions every year in the United States. According to the Centers for Disease Control and Prevention (CDC), close to 2-million victims of trauma require hospitalization annually. In normal times, trauma victims have the benefit of an infrastructure that allows rapid stabilization and transport to a modern medical facility. The off-grid medic, however, has no such access, but is even more likely to be confronted by traumatic injuries.

In survival scenarios, mishaps related to activities of daily survival are bound to occur. Those unaccustomed to, say, chopping wood for fuel could easily end up requiring intervention by someone with medical skills in the event of an accident.

Disclaimer:

This article is for informational purposes only and applies specifically to long-term off-grid scenarios. Improper wound closure can cause more problems than it solves. Seek care by certified professionals wherever a functioning medical system exists.

One of those skills is wound closure. The well-rounded medic should be familiar with the various methods and materials used in closing a laceration. More important still is the proper judgement as to when an open wound should be closed and when it should not. Having the necessary knowledge, training, and equipment is imperative to be an effective caregiver.

The Open Wound

An open wound is any injury that breaches the skin. Skin is your natural armor. It prevents the invasion of microbes into the body that could otherwise be life-threatening. Typical open wounds include:

Above: Skinned knees are a common form of abrasion. Typically, no closure is necessary; clean and dress the wound to reduce the risk of infection.

Abrasions: An abrasion occurs when your skin rubs or scrapes against a rough or hard surface. A motorcyclist’s “road rash” is one example, but most people have “skinned” their knee as children. Bleeding is minimal, but the wound needs to be scrubbed and cleaned to avoid infection. No closure is necessary.

Punctures: A puncture wound is a hole created by a projectile, nail, needle, or certain animal bites. Some punctures may not visibly bleed, but can be deep enough to damage internal organs and increase the risk of infection if closed.

Above: An example of a typical laceration.

Lacerations: For the purposes of this article, we’ll define a laceration as a cut that goes through both the upper layer (epidermis) and the lower layer (dermis) of the skin. Skin lacerations expose the structures underneath to the risk of contamination. Accidents with knives, tools, and machinery may cause lacerations that slice through major blood vessels or even cut deeply into internal organs, like the liver. Bleeding can be extensive. Most lacerations these days are closed by a medical professional.

Avulsions: An avulsion is a tearing away of skin and the soft tissue beneath. Avulsions usually occur during violent accidents, such as crush injuries or shrapnel wounds. Degloving is another gruesome form of avulsion (don’t Google that unless you have a strong stomach). In many cases, these wounds bleed heavily and rapidly. After assuring that bleeding has stopped, closure may be attempted at some point dependent on the amount of tissue lost.

Above: Mountain biking is one activity that can lead to “road rash” abrasions in the backcountry.

Decisions: Primary, Secondary, or Tertiary Intention

When faced with an open wound, you can choose to:

 Close it right away (“primary intention”)
Keep it open and let heal on its own (“secondary intention”)
Keep it open for a time and then close (“tertiary intention”)

Your choice will depend on the situation. Most wounds that you close (primary) heal just fine as long as the wound is flushed with clean drinkable water or a diluted antiseptic solution. This is known as “irrigation” and serves to clear out debris and germs.

Primary Intention: Closure by primary intention usually leads to edges that fit together neatly and, if done properly, drops the risk of infection significantly. It’s important to know that, although skin heals very rapidly, deeper tissues like muscle and tendon take longer to heal and recover full strength.

For wounds that are jagged in nature, a portion of skin may require trimming, also known as “debridement.” This makes the wound more symmetrical and assures the removal of dead tissue that would impede the healing process.

Secondary Intention: Healing by secondary intention leaves the wound open. It’s preferred when wound edges cannot be brought together easily. An example might be a shrapnel wound, where large areas of tissue may be torn off. This may also be used for wounds with a significant amount of dead tissue (like bedsores), which requires debridement.

The process of a wound closing on its own is called “granulation” due to the granular look of newly forming tissue. The larger the wound, the longer it’ll take to fill in. Other factors like the age and general health of the victim play a part in the speed of healing, as does the presence of infection.

These wounds are usually packed with moist (not soaked) sterile dressings, which should be changed at least daily and irrigated with clean water or a diluted antiseptic solution.

Tertiary Intention: Healing by tertiary intention is also known as a “delayed wound closure.” In this strategy, the wound isn’t closed immediately because of suspected contamination. It’s treated like healing by secondary intention for a period of time so that the tissue can be closely observed for signs of infection. If no signs of infection are present after two or three days, the wound may be closed at that time.

Waiting to close is the more prudent approach in many cases where infection is a common complication, like bite wounds. Leaving the wound open for a time allows pus and inflammatory fluid to drain and not accumulate below the skin.

A partial closure is sometimes performed with the placement of a drain. Drains consist of thin lengths of latex, nitrile, or even gauze placed into the wound to allow drainage. “Penrose” drains are a reasonably priced item that are still used in some operating rooms. Don’t be surprised if a drain leaks fluid; be sure to cover any exposed areas.

Many open wounds should be treated with antibiotics to prevent infection whether you close them or not. Natural substances with antibiotic properties, such as raw, unprocessed honey may be useful in survival scenarios.

To Close or Not to Close?

That is the question, as Hamlet would say. It seems like common sense that we would want to close a laceration to speed healing and prevent infection. The decision to close a wound, however, involves developing sound judgment, something that takes some training and experience.

Progress of suture closure over time.

What are you trying to accomplish by closing a wound? Your goals are simple. You close wounds to repair the defect in the body’s armor, to eliminate “dead space” (pockets of air/fluid under the skin which could lead to infection), and to promote healing. Although more an issue in normal times, a neatly closed wound is more cosmetically pleasing.

Closure options include sutures, staples, tapes, or medical glues such as Dermabond. Even industrial superglue has been used (they’re both in the cyanoacrylate family), although the prescription product tolerates getting wet better.

Always use the least invasive method possible to close a wound. Steri-Strips and glues don’t put additional holes in a person, but sutures and staples do. In certain areas, however, it may be necessary to use them. Joints like the knee and elbow are so frequently flexed and extended that tapes and glue are unlikely to hold a laceration together. These wounds should be closed if possible. For that, sutures or staples are required.

You’d think that all wounds should be closed. Unfortunately, closing a contaminated wound can do a lot more harm than good, and could possibly put your patient’s life at risk. Take the case of a young woman injured some years ago in a fall from a zipline — she was taken to the local emergency room, where 22 staples were needed to close a large laceration in her leg. Unfortunately, the wound had dangerous flesh-eating bacteria in it, causing a serious infection which spread throughout her body. She eventually required multiple amputations (including her hands).

Above: Steri-Strips can be placed between sutures or staples to conserve materials.

Despite this tragic case, some wounds are good candidates for closure after a good cleaning. Lacerations that are less than eight hours old are an example. Beyond that, it’s likely that bacteria have already colonized the injury. Even the air has bacteria that can cause infections.

Another case that might call for wound closure is if a laceration is long and deep, cutting through layers of subcutaneous fat, muscle, or other internal structures. A muscle that has been ruptured or torn may not regain its function unless cut edges are approximated. You may also decide to close a wound that gapes open loosely enough to suggest that it can be closed without undue pressure on the skin. The exception might be a puncture wound from an animal bite. These bites are loaded with bacteria and are often kept open.

Is the wound a simple laceration (straight thin cut on the skin) or an avulsion (areas of skin torn out or hanging flaps)? If the edges of the skin are so far apart that they can’t be stitched together without creating undue pressure, the wound should be left open.

Wound Infections

Most wounds you’ll encounter in an off-grid setting will be dirty. If you close a dirty wound, such as a gunshot, you have sequestered bacteria, bits of clothing, and dirt into your patient’s body. Within a short period of time, the wound may show signs of infection.

Above: Animal bites have a higher risk of infection.

An infected wound closure appears red, swollen, and is warm to the touch. In extreme cases, an accumulation of pus called an “abscess” may form. In these cases, stitches would have to be removed and the inflammatory fluid drained. If not recognized quickly, infection may spread to the bloodstream (a condition known as “septicemia”) and become life-threatening.

The Suture Kit

Commercially produced suture kits, also known as “laceration trays” should contain the following items:

 Needle holder
Toothed forceps
Hemostat
Small scissors
Gauze pads
Drapes
Antiseptic (such as Povidone-Iodine solution or Chlorhexidine; usually separate)
Sutures, absorbable and nonabsorbable

The above materials in the tray itself are usually labeled as sterile. Veterinary sutures are acceptable in a pinch as long as they’re also sterile. If uncertain, the needle point may be exposed to heat until red hot, then allowed to cool. An alternative approved for nylon sutures by the National Institute of Health calls for 10 minutes of complete immersion in povidone iodine 10-percent solution. Rinse in sterile water or saline afterward.

Above: Suture kit supplies should include antiseptics and gloves.

One item missing from the list is local anesthetic. Agents like lidocaine with or without epinephrine are prescription drugs. Besides their anesthetic effect on soft tissue, they’re also used for certain cardiac issues. An accidental injection of lidocaine into a blood vessel by an inexperienced medic can lead to life-threatening arrhythmias. Off the grid, anesthetic options may be limited to ice packs or topical ointments. Your experience with this may vary.

As for suture type, it’s best to practice using an inexpensive non-absorbable suture like silk, which is, in my opinion, easier to practice with than some other materials.

Choosing A Closure Method

Let’s say you’ve chosen to close the wound. When choosing a closure method, you should always use the least invasive method possible to close a wound. Surgical tapes and glues approximate wound edges well, but have little tensile strength. Sutures and staples are more invasive.

It’s important to realize that you’ll only have a limited supply of staples and sutures. If you’re down to your last couple of sutures or the last stapler, feel free to mix different closure methods like alternating sutures and surgical tapes, or even adding duct tape improvised into butterfly closures when you’ve run out of medical supplies. You’d be surprised to see what qualifies as medical supplies when the chips are down.

There are several reasons why surgical tapes (Steri-Strips) and glues are used:

 They’re less painful for the patient.
Unlike sutures or staples, they don’t require additional punctures of the skin. As such, there’s less risk for infection.
Materials are less expensive and more easily stockpiled.
In a grid-down disaster setting, advanced closure materials like sutures and staples may no longer be manufactured or distributed. Conservation of these limited supplies is imperative.

Surgical Sutures: In certain areas, such as knee and elbow joints, it may be necessary to use sutures or staples. Sutures are needles and thread used to a sew a wound closed. Unlike staples, they can be used just about anywhere in the body. Some are absorbable; that is, they’re meant to dissolve over time. For the off-grid medic, nonabsorbable sutures like nylon or silk will mostly be utilized for skin lacerations. There are, however, a wide variety of suture types available for just about
any purpose.

Surgical Staples: Much like the staples used to hold paper together, they’re almost as easy to place on the skin with a little training. Staple closures are strong enough to hold a wound closed over joints. A special removing tool is used for removal.

Sutures vs. Staples: Here are some considerations to help you choose between sutures and staples:

Sutures

 Can be used on skin or deep layers
Best for jagged lacerations
More skill required to perform well
Can be performed alone
Many materials from which to choose
More time-consuming
Any scissors can be used to remove, or no removal at all if absorbable sutures are used.

Staples

 Standard versions should be used for skin closure only
Best for straight-line cuts
Less skill required to perform well
Best performed with an assistant
Fewer choices (essentially, standard or large)
Can be accomplished very quickly
Requires special instruments to place and remove properly

Surgical Glue: Medical glues are cyanoacrylates meant for use in lacerations that don’t need a tremendous amount of tensile strength. A good example would be a small laceration on the forearm. Prescription medical glues like Dermabond hold up better to getting wet and are less irritating than regular superglue (which is also a cyanoacrylate). If you must use the industrial version, gels are easier to handle.

To use topical skin adhesive glue:

 Approximate the wound edges carefully (best done with an assistant). If glue gets in the wound, it won’t close.
Gently brush the glue over the laceration, taking care not to push any below the level of the skin.
Apply about three layers of the adhesive over the wound, preferably widening the area of glue each time after drying to increase strength of closure.

Although you’d use antibiotic ointment on most wound closures, avoid it in closures with skin glues; it breaks down the compound. The glue itself, however, helps protect the wound from infection.

Surgical Tapes: Surgical tapes are strips of sterile adhesive material used for simple laceration closure. A popular brand is called “Steri-Strips.” Like medical glues, they work best on small lacerations upon which there is little stress. Placed with a sticky liquid called “tincture of benzoin,” they adhere to both sides of the wound and pull it closed. Steri-Strips last for a few days and often fall off on their own. They can be used in between stitches or staples to provide more support or on top of glue closures.

How to Suture Skin

The process of learning how to suture should be hands-on. We teach it and found that there are few substitutes for having a physician show you how to stitch in person. Certification is rarely available, however, for those who aren’t nurse practitioners, physician’s assistants, or other medical professionals.

It’s also important to realize that, off the grid, it’ll be nearly impossible to duplicate the sterile conditions of an operating room. The best you can hope for is a clean environment that eliminates the majority of microbes.

You’ll need something on which to practice. The best material I have found for teaching is a pig’s foot. The skin of a pig’s foot is probably the closest thing you’ll find to human skin.

Wash your hands and put on sterile gloves. Place the pig’s foot on a level surface and make a “laceration” by cutting straight through the skin with a knife or scalpel. You’ll then perform a “skin prep.” Paint the area to be sutured with a pad dipped in Betadine, Hibiclens, or other antiseptic. Alcohol may be used if nothing else is available. Start at the laceration edges and paint around them in an ever-widening oval. If you have enough materials, repeat three times.

Next, you’ll isolate the “prepped” area by placing sterile drapes. The drape will usually be “fenestrated,” which means it has an opening in the middle to expose the area to be sutured. If not, cut a hole big enough to see the entire wound. Taken together, we refer to this as the “sterile field.” Local anesthesia would be given at this point if available.

Open your laceration tray and the suture packet cover. If you have sterile gloves, put them on now. Take the tip of your needle holder and grasp the curved needle in either the center of the arc (for skin) or one-third of the way from the string end to the needle point for deeper structures. Remove the needle and the attached string from the packet. Adjust the curved needle on the needle holder so that it’s perpendicular (to skin) or slightly outward to the line of the instrument.

The needle holder is held in the dominant hand. If you’re holding the needle holder in your right hand, the sharp end of the needle should point to your left and vice versa. For most purposes, the needle tip should point to the ceiling.

Now take your toothed forceps in your non-dominant hand and grasp the edge of the laceration where you wish to place the first stitch. Right-handers start on the right, left-handers on the left. Insert the suture needle at a 90-degree angle to the skin and drive it through that side of the laceration with a smooth twist of the wrist that follows the needle’s curve. It should enter the skin no closer than a quarter inch from the edge of the laceration.

1. The needle enters the skin at a 90-degree angle.

Release the needle but continue to hold the skin next to it with your forceps so that it stays in place. Re-clamp it, and pull through. Reload the needle on the holder and, going from the inside of the wound, drive the needle with a twist of the wrist through the skin on the other side of the laceration. If the edges are close together, this may be performed in one motion instead of two. If they’re that close together, however, maybe you should have considered surgical tapes instead of sutures?

2. Holding with the forceps, pass the needle through one side.

Pull the string through, leaving a small length on one side. This should leave you with a long side (the side with the needle) and a short side.

3. The needle goes through the other side.

4. Leave the end without the needle very short.

There are various ways to tie your suture, each with its own advantages and disadvantages. In our opinion, the ideal method for the survival medic:

 Has stitches that are independent of each other so that one faulty stitch by an amateur doesn’t unravel the whole closure
Conserves precious suture material
Is easy to learn for the non-medically trained

This method is known as the “interrupted instrument tie.”

Holding the needle holder loosely in the center over the wound, wrap the long end of the string twice over and around the end of the instrument. Then, open the needle holder end slightly and grab the very end of the short end of the suture. Pull it through the loop tightly to the other side. You’ll form a square knot, also called a “Surgeon’s Knot.” Repeat the instrument loop several more times. Only one loop around the needle holder is required for every knot after the first. Four or five knots on top of each other should do.

5. Loop the long end twice around the needle holder head.

6. Surgeon’s knot in place

Finally, grasp the two ends of the string and cut the remaining suture material ¼ inch from the topmost knot with your suture scissors. If you have a good supply of suture material, place each subsequent suture about ½-inch apart from the previous one, especially if over a joint (see below). In situations where suture availability is limited, you may choose to fill in areas between sutures with surgical tapes if the laceration isn’t over a joint.

7. Each successive knot uses only one loop.

It’s important to tighten your knots only enough to close the wound. Approximate, don’t strangulate. Excessive pressure from a knot that’s too tight will prevent healing in the area of the suture. You can easily identify sutures that are too tight — they cause an indentation in the skin where the string is. To complete your suture procedure, apply some antibiotic cream or raw, unprocessed honey. Then cover with a light dressing.

8. Perform several knots per stitch. Grasp both ends and cut at about ¼ inch from the knots.

Once the closure is done, keep the wound dry and covered for 48 hours, checking it several times a day. Sutures or staples on the skin should typically be removed in seven days; if on the face, remove after five days; if over a joint, remove after no less than 14 days.

Suture After Care

Most wounds closed with sutures should be covered with an antibiotic ointment and a nonadhesive dressing for the first 48 hours or so. Antibiotic ointments like Bacitracin or Triple Antibiotic reduce the rate of infection from 18 to 5-6 percent. These products, however, degrade surgical glue closures and shouldn’t be used in those instances.

How to Staple Skin

After thoroughly cleaning a wound and applying antiseptic to “prep” the surgical field, you’re ready to use your skin stapler. Your assistant will need two Adson’s forceps to hold the skin for you. Position yourselves on either side of the patient. Both you and the assistant should wear sterile gloves.

Above: The middle of the stapler is clearly delineated.

Most staplers are held in the dominant hand the same way you would hold, say, a garden hose nozzle. Stand in a position so that you have an overhead view of the laceration to be closed.

Your assistant then grabs the edges of the skin with the two forceps. They’ll then evert the edges (turn them inside out) slightly and gently press them together.

Above: Adson’s forceps are used to approximate the skin; the staple is then placed.

Hold your stapler at a 60-degree angle to the approximated edges and press firmly downward on the raised edges of the skin. The line of the laceration should be right in the middle of the line of the stapler.

Press the “trigger” of your stapler to embed the staple; then, release and retract. Check the staple placement and remove any that aren’t appropriately executed. The skin should appear slightly “tented up” if the staple was placed correctly. Place subsequent staples ½-inch apart, especially in areas over a joint. If not over a joint, they can be spaced more widely apart, with surgical tapes placed between in-between.

Above: Staple intervals are dependent on the location.

To remove staples, you’ll need an instrument that’s (unsurprisingly) known as a staple remover. This instrument is similar to office staple removers of bygone days. Place the “mandible” of the staple remover between the healed skin and the staple. Some brands contain two prongs on the lower blade and one on the upper. When the two prongs are under the staple, press the handles together; the top prong will press on the staple in such a fashion that the staple is easily lifted and removed. Repeat until all staples are removed.

Above: A staple remover is needed to easily take out staples.

When to Remove Sutures or Staples

The longer sutures are in place, the higher the chance they may become embedded in the skin and cause scarring. On fine skin on the face, five days is often enough. On regular skin, like your forearm, a week to 10 days should do. Consider two weeks or more if the closure involves a joint, like the knee. If you’re not sure about the strength of healing, take one or two alternating stitches out in the middle and observe for skin edge separation.

Common Suturing Mistakes

Too Tight: Over-tightening causes skin to invert and prevents laceration edges from touching (and thus healing). It may also delay formation of new blood vessels in the area of the suture closure.

Too Loose: Skin edges should be touching and not gape open.

Not eliminating “dead space:” Dead spaces are pockets of air or fluid that accumulate under a skin closure. If you can’t approximate the entire wound with one series of sutures, consider placing deeper layers of (absorbable) suture first.

Misaligned sutures: Sutures not directly across on each side leave leftover skin at the end. Be certain to align perpendicular to the wound edge. Avoid making sutures that appear diagonal to the wound.

Uneven thicknesses: Taking a deep “bite” on one side and then going superficial on the other leaves one skin edge higher than the other. Make sure to take bites on each side that are as identical as possible.

Not beginning with a Surgeon’s Knot: Double looping on the first instrument tie will prevent slippage that causes excessive loosening.

Not using fine-enough sutures: Delicate areas like the face should be sutured with as small a suture as you can competently handle. Scars from needle holes are more noticeable with bigger needles and thicker string.

Using too fine a suture: Over joints, too thin or small a suture may not be able to handle the stress of movement.

Leaving sutures in place in obvious infections: Follow the wound healing process closely. If pus is noted, remove all sutures and consider allowing to heal by secondary intention.

Sutures placed too close to the wound edge: Take enough skin on each side to give strength to the closure. One-fourth of an inch is about right for most closures. It’s better to have a suture a little too wide than too narrow.

Conclusion

It’s important to realize that every surgeon may have their preferred way of closing a wound that differs from the above. Ask five surgeons, get five answers. Medicine is as much an art as it is a science.

There’s a lot more that goes into proper education and training in wound closure than is found here, but with some commitment and determination, the off-grid medic can learn this important aspect of medical care.

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