BOWEL AND TENDON SUTURES. 143 



For this reason Jobert's suture was discarded in favour of Lam- 

 bert's, in which the threads are passed in a similar way but do not 

 penetrate the mucous membrane, only extending to the muscular coat 

 (Fig. 170). 



Czerny reinforces Lembert's stitch by interrupted sutures uniting 

 the mucous membrane, Lembert's stitch being employed to bring the 

 serous surfaces into apposition ; he thus unites the edges of the wounds 

 twice. The tirst series do not penetrate deeper than the submucous 

 tissue. This system, however, is difficult to carry out. It is much 

 easier if the suture begins and ends in the serous coat ; the knots then 

 lie externally between the two surfaces of peritoneum. 



In isolated instances it may be desirable to unite the mucous 

 membrane itself. In such cases the first half or more of the incision 

 should be sutured from within, and the knots tied on the inner surface. 

 As, however, the wound becomes smaller this is no longer possible, 

 and the remaining half of the wound must be united with sutures 

 penetrating to the submucous coat but tied externally. The whole of 

 the wound having thus been closed, the serous surfaces are brought 

 together in the manner above indicated. It might be advisable in 

 cases where other tissues lined with mucous membrane are divided, as 

 for instance the eyelids, cheeks, salivary or urinary ducts, the cesophagus 

 or bladder, to proceed as above, uniting mucous membrane to mucous 

 membrane. The apposition of secreting surfaces should be avoided. 



Tendon Sutures. — In man recently ruptured tendons are united 

 by deep catgut or reindeer tendon ligatures left in position. In such 

 case the paratendinous connective tissue is turned inwards like the 

 serous coat in the last instance, because it contains the vessels and 

 most readily unites. The needle is inserted about a quarter of an inch 

 from the divided end of the tendon, carried (say) downwards beneath 

 the superficial layers of tendon fibres, brought out through the torn 

 surface, and passed through the opposite end of the tendon after a 

 similar but reversed fashion. The ends are knotted and cut off. If 

 necessary, a complete ring of sutures ma}^ thus be inserted around the 

 tendon, after which the outer wound is closed. It is often extremely 

 difficult to insert sutures because the muscles retract the ends of the 

 tendon to a considerable distance. The divided ends mav, however, 

 often be approximated by placing the limb in a special position, in 

 which it must afterwards be fixed by the application of a dressing, 

 plaster bandage, or splint, etc., secured as circumstances will permit. 

 This procedure might be imitated in small animals. In the present 

 condition of our science, however, it is practically impossible to 

 insert sutures in those tendons which are most frequently ruptured, 



