Where cosmetic result is not a considera-
tion, sutures may be slightly further apart.
Generally, the distance of the needle bite
from the wound edges should be equal to
the distance between sutures.
When subcutaneous sutures are needed,
it is proper to use 4-0 chromic catgut.
When deciding the type of material to use
on skin, use the finest diameter that will
satisfactorily hold the tissues.
Children under 3 yrs, face:
All other faces
Feet, elbows, knees
#34 or #36 wire or 4-0
6-0 or 5-0
When cutting sutures, subcutaneous
catgut should have a 1/16 inch tail. Silk
skin sutures should be cut as short as is
practical for removal on the face and lip.
Elsewhere, skin sutures may have longer
tails for convenience, but a tail over 1/4
inch is unnecessary and tends to collect
The following general rules can be used
in deciding when to remove sutures:
Face: As a general rule, 4 or 5 days.
Better cosmetic results are obtained by
removing every other suture and any
suture with redness around it on the
third day and the remainder on the
Body and scalp: 7 days.
Soles, palms, back or over joints: 10
days unless excess tissue reaction is ap-
parent around the suture, in which
case they should come out sooner.
Any suture with pus or infection
around it should be removed im-
mediately, since its presence will make
the infection worse.
When wire is used, it may be left in
safely for 10 to 14 days.
Shock is the collapse of the cardiovascular
system, characterized by circulatory deficiency
and depression of vital functions. There are
several types of shock. Hypovolemic shock is due
to diminished blood volume; neurogenic shock
results from the loss of vascular control by the
nervous system; cardiogenic shock is due to
inadequate functioning of the heart; septic shock
develops in the presence of severe infection; and
anaphylactic shock is due to an allergic reaction.
Multiple types of shock maybe present in varying
degrees in the same patient. The most frequently
encountered and most important type for the
corpsman to understand is hemorrhagic shock,
a type of hypovolemic shock.
In shock, the diminished blood volume causes
a markedly lessened cardiac output and reduced
peripheral circulation. This results in a lowered
transport of oxygen to the tissues (hypoxia);
decreased perfusion, the circulation of blood
within an organ; and a lowered transport of waste
products away from the tissue cells. Under these
conditions, body cells are able to carry on their
normal functions for only a short period of time.
Soon they begin to malfunction and then shut
down. Certain cells, especially in the heart, brain,
liver, and kidneys, are highly susceptible to tem-
porary or permanent damage. Permanent renal
shutdown is an ever present danger in shock.
Shock should be expected in all cases of gross
hemorrhage, abdominal or chest wounds, crush
or blast injuries, extensive large muscle damage,
particularly of the extremities, major fractures,
traumatic amputations, head injuries, burns in-
volving more than 10 percent of the body surface
area, or any other major injury.
Figure 4-51.Symptoms of shock.