138 OPERATIVE TECHNIQUE. 



Sutures ma}- be tied successively as inserted, or tying may be 

 deferred until all are in place. In animals it is usually best to tie them 

 as one proceeds. The fear of them tearing out when the animal rises 

 is unjustified, provided a sufficient number have been used and one or 

 more " relaxation " or " tension " sutures have been inserted. Bayer 

 always sutures wounds left after the removal of elbow tumours (capped 

 elbow), and although the sutures are exposed to great strain on the 

 animal rising he has never seen them tear out. In this country, of 

 course, such tumours are not infrequently removed in the standing 

 position under local anaesthesia, and the danger of tearing out is 

 therefore comparatively trifling. 



The knots should lie to one side or other of the line of union, not on 

 the wound. The threads are cut off short. When the lips of the 

 wound are thin they often tend to turn inwards when sutured and to 

 delay union. This cannot take place where a fold is raised, but should 

 it occur it can easily be rectified by raising the edges with dissecting 

 forceps and holding them in this position until the sutures are tied. 



In tying a surgical knot the free end of the thread is twisted twice 

 around the fixed end when forming the first portion of the knot. To 

 remove sutures the knots are grasped with forceps, the loops lifted 

 sufficiently to allow the points of the scissors to be slipped gently 

 beneath, and the threads cut and withdrawn. Should a thread stick, 

 the lips of the wound may be supported with the free hand whilst the 

 thread is being extracted. As already remarked, catgut is completely 

 absorbed, so that only the portion of the suture outside the wound 

 requires removal. 



The continuous suture or glover's stitch (Fig. 162) is, after the 

 interrupted (Fig. 159), probably that most commonly employed. It 

 begins at one end of the wound like an ordinary interrupted suture. 

 After t}-ing the first suture the thread, however, is not cut oft', 

 but is carried obliquel}' across the lips of the wound and rein- 

 serted on the opposite side, the needle being passed once more 

 at right angles through the edges of the wound, which must be 

 held in close apposition. In this wa}- the thread passes con- 

 tinuously from one end of the wound to the other. At the point 

 where it finally emerges it is cut off and tied at one side of the 

 wound, so that the beginning and end resemble an ordinary inter- 

 rupted suture. Another method consists in leaving the ends, free 

 until the suture is complete, when they can be knotted together, 

 forming a long loop. In removing this suture the thread is divided at 

 each loop, and the fragments withdrawn one by one. The glover's 

 stitch has the advantage of being rapidl}' inserted, but many regard it 



