Page 73 - PJ MED OPS Handbook 8th Ed

4. Select appropriate suture material:
a. 4-0 Nylon is the best choice for closure of general skin wounds
b. 5-0 or 6-0 Nylon should be used for closure of facial wounds
c. 4-0 Vicryl or gut (not nylon) is appropriate for closure of deep tissue

NOTE: Vicryl should not be used on skin as it is absorbed through an inflammatory response
that will lead to excessive scarring.

5. Using interrupted sutures, close the wound with sufficient stitches to align the wound edge and
prevent gaps. Use running and locking suture for bleeding wound.
6. Dress the wound appropriately.
7. Monitor for signs of infection.
8. If evidence of infection occurs, remove stitches and apply appropriate dressings; consider antibi-
otics if signs of cellulitis are present (moxifloxacin).
9. Most sutures should be removed in 7–10 days, facial sutures in 5 days.
PJ PEARLS:
• Use a figure 8 suture around a bleeding vessel or site.
• If uncertain about closing any wound leave it open to heal.

Delayed Primary Closure
Indications:
Technique of choice for management of dirty or contaminated wounds occurring in a combat envi-
ronment that cannot be taken to higher level medical care within 12–14 hours. In most cases, the
secondary closure will be done after timely evacuation to a higher level of care.

CAUTION: Delayed primary closure should NOT be done on the face.

Procedure:
1. Anesthetize the wound and control any bleeding. Debride any necrotic tissue and irrigate wound
removing all visible foreign bodies and debris.
2. Place a single layer of fine mesh gauze into the wound, and then loosely pack the wound with
Kerlex or fluffs.
3. Apply a Kerlex bulky dressing around the wound, keep the dressing clean and dry.
4. Change dressing every 24 hours and monitor for signs of infection (fever, foul drainage or severe
pain/redness around site).
5. After three days, remove the dressing and inspect the wound. If the wound appears clean and
has no apparent infection, debride the wound again, then close with sutures in conjunction with
medical consultation, if available.

Chapter 6. Surgical and Medical Procedures n 71