contract when pinched, nor does it bleed when
cut. If this type of tissue is evident, do not close
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
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 itand then only if
he has observed and assisted in numerous
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.
In modern surgery, many kinds of ligature and
suture materials are used. All can be grouped into two
nonabsorbable sutures and absorbable
NONABSORBABLE SUTURES.These are
sutures that cannot be absorbed by the body cells and
fluids in which they are embedded during the healing
process. When used as buried sutures, these sutures
become surrounded or encapsulated in fibrous tissue
and remain as innocuous foreign bodies. When used as
skin sutures, they are removed after the skin has
healed. The most commonly used sutures of this type
and the characteristics associated with each are listed
Silkfrequently reacts with tissue and can be
spit from the wound.
¾loses tensile strength with each
¾is better than silk or cotton but is more
expensive and not as readily available.
Synthetic materials (e.g., nylon, dermalon)
are excellent, particularly for surface use. They
cause very little tissue reaction.
problem seems to be the tendency for the knots to
come untied. (Because of this tendency, most
surgeons tie 3 to 4 square knots in each such
suture.) Nylon is preferred over silk for face and
lip areas because silk too often causes tissue
Rust-proof metal (usually stainless steel wire)
has the least tissue reaction of all suture
materials and is by far the strongest. The primary
problems associated with it are that it is more
difficult to use because it kinks and that it must
be cut with wire cutters.
ABSORBABLE SUTURES.These are sutures
that are absorbed or digested during and after the
healing processes by the body cells and tissue fluids in
which they are embedded. It is this characteristic that
enhances their use beneath the skin surfaces and on
Surgical gut fulfills the requirements for the
perfect sutureease of manufacture, tensile strength,
and variety availablemore often than any other
Manufacture of catgut: Though it is referred to
as catgut, surgical gut is derived from the
submucosal connective tissue of the first
one-third (about 8 yards) of the small intestine of
healthy government-inspected sheep.
intestine of the sheep has certain characteristics
that make it especially adaptable for surgical use.
Among these characteristics is its uniformly
fine-grained tissue structure and its great tensile
strength and elasticity.
Tensile strength of catgut: This suture material
is available in sizes of 6-0 to 0 and 1 to 4, with 6-0
being the smallest diameter and 4 being the
largest. The tensile strength increases with the
diameter of the suture.