Varieties of catgut: Surgical gut varies from
plain catgut (the raw gut that has been gauzed,
polished, sterilized, and packaged) to chromic
catgut (that has undergone various intensities of
tanning with one of the salts of chromic acid to
delay tissue absorption time). Some examples of
these variations and their absorption times
follow in table 4-3.
Suture needles may be straight or curved, and they
may have either a tapered round point or a cutting edge
point. They vary in length, curvature, and diameter for
various types of suturing. Specific characteristics of
suture needles are listed below.
Size: Suture needles are sized by diameter and
are available in many sizes.
Taper point: Most often used in deep tissues,
this type needle causes minimal amounts of
Cutting edge point: This type needle is
preferred for suturing the skin because of the
needle's ability to penetrate the skin's toughness.
Atraumatic (atraloc, wedged): These needles
may either have a cutting edge or a taper point.
Additionally, the suture may be fixed on the end
of the needle by the manufacturer to cause the
least tissue trauma.
Preparation of Casualty
Before suturing the wound(s) of any victim, the
following steps should be taken to prepare the casualty.
1. Examine the casualty carefully to determine
what materials are needed to properly close the
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
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
patients 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
epinephrine must never be used on the fingers, toes,
ears, noseany appendage with small vesselsbecause
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. DO NOT attempt 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
B: Mild chromic
C: Medium chromic
D: Extra chromic
Table 4-3.Absorption Times of Various Types of Surgical