SUTURES. 



103 



Fig. 137. — Showing method of using needle-holder. 



they may heal by primary intention, provided the margins are not 

 absolutely crushed, have not lost their vitality, and have not been 

 cut off from the circulation. Tissues in which the circulation has 

 been reduced to an absolute minimum may still retain their vitality 

 by means of the " plasmatic " infiltration until circulation of blood 

 by the formation of new blood-vessels becomes possible, and small 

 fragments of dead 

 tissue can be cast off 

 without imperilling 

 primary union. 



Deep wounds are 

 often left open because 

 of the danger of in- 

 fection from retained 

 discharges. By using 

 drainage-tubes , h o w- 

 ever, some of these 

 may be united without 

 bad consequences. On 

 the other hand, great 



tension, especially in wounds with loss of substance, contra-indicates 

 the use of sutures, which would rapidly cut out, and would 

 therefore only be a drawback. Moreover, those portions of the lips 

 of the wounds enclosed within the threads might themselves die, 

 increasing the loss of substance. 



Lacerated wounds, especially when deep or very irregular, are 

 sometimes left u n - 

 sutured, but when 

 muscles have been torn 

 and the margins of the 

 wound are not puckered 

 or necrosed sutures 

 should be inserted. In 

 such wounds the sutures 

 may not remain in position 

 serve to promote union in a 



It is inadvisable to remove irregular fragments from the edges of 

 a lacerated wound, because although the pared lips may more closely 

 approximate to a straight line, sound tissue may be removed, the 

 wound is enlarged, and the tension on the sutures must be increased. 



Sutures are therefore only contra-indicated when marked tension 

 exists, or when the wound suppurates or is offensive. Almost all 



Needle-holder (Hagedorn's). 



for more than a few 

 regular manner. 



days, but they 



