the discharge of pus, and persistent fever
or toxemia, DO NOT 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 solutions. These aid in the liquefac-
tion 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 under the indica-
tion of a healthy appearance of the wound.
Healthy muscle tissue that is viable is evi-
dent by its color, consistency, blood sup-
ply, 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.
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
(great care always being exercised to suture mus-
cle fibers end-to-end and to correctly appose them)
and the wound is closed in layers. This is ex-
tremely delicate surgery and the corpsman should
exercise independent judgment on the advisability
of attempting it, and then only if he or she has
observed and assisted in numerous surgical
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
works. The corpsman should wear a cap and
mask, scrub his or her hands and forearms, and
wear sterile gloves.
In modern surgery, many kinds of ligature and
suture materials are used. All can be grouped into
Nonabsorbable sutures: Those that cannot
be absorbed by the body cells and fluids
in which they are embedded during the
healing process. When used as buried
sutures, they become surrounded or encap-
sulated in fibrous tissue and remain as in-
nocuous foreign bodies. When used as skin
sutures, they are removed after the skin has
healed. The most commonly used of this
type of sutures and facts associated with
Silk: frequent tissue reaction or spit-
ting of suture from the wound.
Cotton: loses tensile strength with each
Linen: better than silk or cotton but
more expensive and not as readily
Synthetic material: there are many, such
as nylon and dermalon. These are ex-
cellent, particularly for surface use.
They cause very little tissue reaction.
Their only problem seems to be the
tendency for the knots to come untied,
so most surgeons tie 3 to 4 square knots
in each suture. Nylon is preferred over
silk for face and lip areas because silk
too often causes tissue reactions.
Rust-proof metal: usually stainless steel
wire or tantalum. This has the least
tissue reaction of all suture material and
is by far the strongest. The primary
problems are the need for wire cutters,
and it is more difficult to use because
Absorbable sutures: Those that are ab-
sorbed or digested by the body cells and
tissue fluids in which they are embedded
during and after the healing processes. It
is this characteristic that enhances their use
beneath the skin surfaces and on mucous