1. Examine the casualty carefully to determine what materials are needed to properly close the wound.

a. Select and prepare sterile instruments, needles, and suture materials.

b. Position the patient securely so that access to the wound and suture tray is optimal. It is usually not necessary to restrain patients for suturing.

c. Make sure a good light is available.
2. Strictly observe aseptic wound preparation. Use mask, cap, and gloves. Thorough cleaning and proper draping are essential.

3. Select an anesthetic with care. Consider the patient's tolerance to pain, time of injury, medications the patient is taking or has been given, and the possible distortion of the tissue when the anesthetic are infiltrated.

SELECTION OF ANESTHESIA.-The most common local anesthetic used is Xylocaine, which comes in various strengths (0.5%, 1%, 2%) and with or without epinephrine. Injectables containing epinephrine must never be used on the fingers, toes, ears, nose-any appendage with small vessels-because of the vasoconstricting effect of the epinephrine. Epinephrine is also contraindicated in patients with hypertension, diabetes, or heart disease.

The three methods of anesthestia administration are topical, local infiltration, and nerve block. Topical anesthetics are generally reserved for ophthalmic or plastic surgery, and nerve blocks are generally accomplished by an anesthesiologist or anesthetist for the surgical patient. For a Corpsman, topical anesthesia is limited to the instillation of eye drops for mild corneal abrasions after all foreign bodies have been removed. DONOTattempt to remove embedded foreign bodies. Nerve blocks are limited to digital blocks wherein the nerve trunks that enervate the fingers or toes are anesthetized. The most common method of anesthesia used by a Corpsman is the infiltration of the anesthetizing agent around a wound or minor surgical site.

ADMINISTRATION OF ANESTHESIA.- Performing a digital block is a fairly simple procedure, but it should not be attempted except under the supervision of a medical officer or after a great deal of practice. The first step is cleansing the injection site with an antiseptic solution. The anesthetizing agent is then infiltrated into the lateral and medial aspects at the base of the digit with a small bore needle (25-or 26-gauge), taking care not to inject into the veins or arteries. Proper placement of the anesthesia should result in a loss of sensitivity in a few minutes. This is tested by asking the patient if he can distinguish a sharp

Type Gut Absorption Time
A: Plain 10 days
B: Mild chromic 20 days
C: Medium chromic 30 days
D: Extra chromic 40 days

Table 4-3.-Absorption Times of Various Types of Surgical Gut

sensation or pain when a sharp object is gently applied to the skin.

Administering local anesthesia is similar except you are anesthetizing nerves immediately adjacent to where you will be working instead of nerve trunks. There are two generally accepted methods of infiltrating the anesthesia. One is through the skin surrounding the margin of the wound and the other is through the wound into the surrounding tissue. In either case, sufficient quantities must be infiltrated to effect anesthesia approximately 1/2 inch around the wound, taking care not to inject into a vein or artery.

CAUTION: The maximum recommended amount of Xylocaine to be used is 50 cc for a 1% solution or the equivalent.