TREATMENT OF WOUNDS 105 



Suturing the Skin Flap 



At this stage of the procedure the veterinarian should 

 don a pair of sterilized skin-tight gloves or else handle 

 needle and thread with the needle-holder, with the aid of 

 an assistant to keep the dangling end from trailing 

 about over soiled places. The former method — the wear- 

 ing of gloves — is the better, because suturing can then 

 be done much faster and also more accurately. The first 

 effort is to baste the flap with crucial sutures arranged 

 somewhat loosely and about one inch apart, some care 

 being taken to bring the flap to the place it actually 

 belongs in order to prevent wrinkling and to avoid ten- 

 sion. This basting process is of great importance, be- 

 cause if it is w^ell done the rest is a mere routine. The 

 edges themselves are not yet approximated; there is a 

 gap along the entire flap. An accurate approximation is 

 now effected with interrupted sutures placed one quarter 

 of an inch apart and about three sixteenths of an inch 

 from the edges. Every fourth or fifth stitch of these 

 interrupted sutures is made longer — about a quarter of 

 an inch from the edges, or even more. The latter sutures 

 are retaining sutures, like the crucial sutures, while the 

 short ones are the real approximating media. The short 

 sutures tend to prevent the infolding of edges that is sure 

 to be produced by the longer ones. Infolding of the 

 edges must be corrected at every point, as union is impos- 

 sible unless the raw edges are brought into contact. 

 Every part is thus closed up except the place planned 

 for the drainage orifice. The size of the orifice or counter 

 opening specially made must harmonize with the size of 

 the traumatic cavity. A large wound will require a 

 larger opening than a small wound, because a free outlet 

 is essential. 



