LEARNING OBJECTIVE: Recognize the different types of suture material and their uses; recall topical, local infiltration and nerve-block anesthetic administration procedures; and identify the steps in wound suturing and suture removal.

The care of the wound is largely controlled by the tactical situation, facilities available, and the length of time before proper medical care may be available. Normally, the advice to the Corpsman regarding the suturing of wounds is DO NOT ATTEMPT IT. However, if days are expected to elapse before the patient can be seen by a surgeon, the Corpsman should know how to use the various suture procedures and materials, and how to select the most appropriate of both.

Before discussing the methods of coaptation (bringing together), some of the contraindications to wound closing should be described.

If there is reddening and edema of the wound margins, infection manifested by the discharge of pus, and persistent fever or toxemia, DONOT CLOSE THE WOUND. If these signs are minimal, the wound should be allowed to "clean up." The process may be hastened by warm, moist dressings, and irrigations with sterile saline. These aid in the liquefaction of necrotic wound materials and the removal of thick exudates and dead tissues.

If the wound is a puncture wound, a large gaping wound of the soft tissue, or an animal bite, leave it unsutured. Even under the care of a surgeon, it is the rule not to close wounds of this nature until after the fourth day. This is called "delayed primary closure" and is performed upon the indication of a healthy appearance of the wound. Healthy muscle tissue that is viable is evident by its color, consistency, blood supply, and contractibility. Muscle that is dead or dying is comparatively dark and mushy; it does not contract when pinched, nor does it bleed when cut. If this type of tissue is evident, do not close the wound.

If the wound is deep, consider the support of the surrounding tissue; if there is not enough support to bring the deep fascia together, do not suture because dead (hollow) spaces will be created. In this generally gaping type of wound, muscles, tendons, and nerves are usually involved. Only a surgeon should attempt to close this type of wound.

NOTE: To a certain extent, firm pressure dressings and immobilization can obliterate hollow spaces. If tendons and nerves do not seem to be involved, absorbable sutures may be placed in the muscle. Be careful to suture muscle fibers end-to-end and to correctly appose them. Close the wound in layers. This is extremely delicate surgery, and the Corpsman should weigh carefully the advisability of attempting it-and then only if he has observed and assisted in numerous surgical operations.

If the wound is small, clean, and free from foreign bodies and signs of infection, steps should be taken to close it. All instruments should be checked, cleaned, and thoroughly sterilized. Use a good light and position the patient on the table so that access to the wound will be unhampered.

The area around the wound should be cleansed and then prepared with an antiseptic. The wound area should be draped, whenever possible, to maintain a sterile field in which the Corpsman will work. The Corpsman should wear a cap and mask, scrub his hands and forearms, and wear sterile gloves.

Suture Materials
In modern surgery, many kinds of ligature and suture materials are used. All can be grouped into two classes: nonabsorbable sutures and absorbable sutures.