SUTURE NEEDLES AND MATERIALS. 135 



largely employed for suturing skin wounds where immediate union 

 is of much importance. Soft metallic wire and prepared horsehair are 

 also used. To preserve silk and catgut in an aseptic condition the 

 special holder shown in Fig. 82 is ver}' practical. 



General Directions for inserting Sutures. — Before in- 

 serting sutures bleeding must have completely ceased. Capillary 

 haemorrhage is sometimes stopped by the sutures themselves, the 

 bleeding surfaces being pressed together ; but any large bleeding 

 vessels should be ligatured or twisted, otherwise the object of 

 suturing will be defeated. All foreign bodies, and not merely those 

 of a macroscopic character like fragments of dirt from the wounding 

 body, or of crushed tissues, clots of blood, etc., but also organisms 

 which would set up inflammation and suppuration, must be removed. 

 This is effected by shaving the hair from around the wound and wiping 

 and rinsing the parts carefully. Wounds are in the most favourable 

 condition for union when all bleeding has ceased and the surfaces 

 are covered with a thin film of clear serum. Although in human 

 surgery only sterilised, that is, aseptic, dressings and sterilised 

 water are used, it is much better in animals to use some antiseptic, 

 because in their case wounds are much oftener infected from the 

 beginning, and have usually been inflicted a considerable time before 

 coming under the surgeon's notice. 



The preceding measures having been carried out. the lips of 

 the wound are approximated, and a decision formed as to the 

 number, kind, and arrangement of the sutures to be used. The 

 number, of course, depends on the size of the wound, and the kind 

 on the tissue to be united — whether it be skin, bowel, muscle, etc. 

 The first suture is best inserted where the parts are most out of 

 line. In very long wounds a series may first be placed at somewhat 

 long intervals, so as to ensure the approximately correct apposition 

 of the edges before proceeding to final closure. 



Sutures must be so inserted as to bring the lips of the wound into 

 close contact at all points, and it is better to err on the side of using too 

 many than too few. In mucous membranes, bowel, etc., more sutures 

 are necessary than in the case, say, of skin. Their distance apart 

 ranges between three sixteenths and three eighths of an inch. The 

 points of entrance and margins should be at equal distances from the 

 borders of the wound, and in the case of the skin not less than three 

 eighths of an inch. The old rule, however, that the needle should be 

 inserted at a distance from the edge equal to the depth of the wound, 

 so that the surfaces should touch throughout their extent and no open 

 space remain below the suture, is not always to be followed ; one is 



