TENSION SUTURES— SUTURES OF RELANATION. 141 



be removed without disturbing the rest (Fig. 166). As, however, these 

 rolls of gauze become hard when saturated with blood or discharge, 

 they may advantageously be replaced with small pieces of disinfected 

 rubber tube, w'hich can easily be cleaned, and which yield slightl}' 

 when swelling occurs. In long wounds comparatively thick drainage- 

 tubes may be used, sufficiently long to extend beyond the ends of the 

 wound, thus reproducing the old form of suture shown in Fig. 165. 

 This secures the advantages of greater cleanliness and a certain 

 yielding quality, which permits of the longitudinal tube adapting itself 

 to irregularities of surface, and thus exercising more regular pressure. 

 Should a suture threaten to cut, the drainage-tube may be divided at 

 any point, and the compound suture converted into interrupted ones. 



Another form of tension suture is shown in Fig. 167. The free ends 

 of the silver wire are passed through small oval plates of any light 



; '1 



]tlt:X-^t^X^. 



fc^..*%&-."S 



CyO 



Fig. 166. — Interrupted sutures combined 

 with sutures of relaxation. 



—Tension suture iii 

 position. 



metal like aluminium, and secured by perforated shot slipped over the 

 wire and compressed by pliers. Occasionally the plates are omitted, 

 and small leaden shot or glass beads alone used. The suture is then 

 secured by forming a rather large knot above the bead at each end. 



Bowel Sutures. — For uniting the walls of the bou^el many com- 

 plicated methods have been proposed, some of which certainly were of 

 value in pre-antiseptic days, but are now discarded. Possessing as we 

 do suture materials which may safely be abandoned in the abdominal 

 cavity wdthout setting up suppuration, peritonitis, etc., many special 

 precautions are now unnecessar}-. The sutures hereafter described 

 are those most frequently employed and easiest to use. In devising 

 a bowel suture, it must be borne in mind that mucous membrane 

 will not readily unite with mucous membrane on account of the 

 continuous secretion occurring, and that the surfaces to bring together 



