140 



OPERATIVE TECHNIQUE. 



hand, when the threads can be cut and the pins removed. Threads 

 gkied to the skin by discharges may, if aseptic, be left in position. 



Another form of suture comparatively little employed is the so- 

 called shoemaker's stitch. It is used in removing hernial sacs, new 

 growths, etc. An awl-like needle carrying a long thread is passed 

 through the new growth, and the loop is cut, leaving the growth 

 transfixed with two threads. By tightly tying together the free ends 

 of these threads on opposite sides the circulation in the peripheral 

 portion of the growth is stopped, causing the part to become necrotic 

 and fall away. By using a series of such sutures large growths may 

 effectually be removed. 



Of tension sutures or sutures of relaxation there are several 

 varieties. Ordinary interrupted sutures may be used for this purpose 

 if more widely spaced and inserted further from the edges of the 

 wound and to a greater depth than usual (see Fig. 164). 



Fig. 164. — Ordinary deeply placed 

 interrupted sutures used as 

 sutures of relaxation. 



Fig. 165. — So-called "quilled" suture. 



To equalise and distribute pressure, thus preventing the stitches 

 cutting through the skin, the suture shown in Fig. 165 is often 

 used. It is formed by passing a number of double sutures through 

 the lips of the wound in such a way that the loops lie on one 

 side, the free ends on the other. A small cylinder of any kind, like a 

 quill or roll of gauze, is then slipped through the loops ; the free ends 

 are drawn tight and tied over a similar cylinder inserted on the 

 opposite side. The cylinders extend for some distance beyond the 

 ends of the wound. 



It happens, howe\-er, at times that animals lie on the part so 

 secured, and the c}-linders are apt to cause pressure necrosis, making 

 it necessary to remove the whole of the sutures despite their still being 

 required. A modification was therefore introduced in which small 

 rolls of gauze are employed for each complete suture, allowing one to 



