Vm AND OTHER SUTURES. 109 



is carried obliquely across the lips of the wound and reinserted 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 apposi- 

 tion. In this way the thread passes continuously 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 interrupted 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 withdrawn one by one.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 rapidly inserted, but many regard it with disfavour. Despite 

 the greatest precautions the wound cannot always be maintained 

 aseptic. If the glover's stitch has been used, and it should become 

 necessary to relax or remove a thread here and there, the whole 

 wound reopens. 



In the blanket or button-hole stitch (another form of continuous 

 suture) the needle, after traversing the lips of the wound, is carried 

 under the slack of the thread, so that the loop of each stitch as it 

 is tightened is maintained at right angles to the edge of the wound, 

 whilst the intermediate portion lies parallel to it. 



The pin suture, also known as the twisted or figure-of-8-suture 

 (Fig. 144), though much praised by certain operators is less often 

 used than formerly. It is employed where the edges of the skin 

 are very thin and without much subcutaneous tissue, as, for example, 

 in the eyelid, wing of the nostril, skin of the cheek, lip, etc., and 

 where the margins show a tendency to roll inwards. The pin then 

 acts as a support for the edges of the skin. The pins are usually 

 from one and a half to two inches in length, and parallel sided. 

 They should be flexible, and may be of brass, copper, silver, etc. 

 Ordinary pins, however, are often used. They are sometimes inserted 

 with a special instrument which holds the pin in a short tube provided 

 with an awl-shaped handle ; or with the aid of a pin director or 

 grooved needle. The pin-director is passed through the edges of 

 the wound, and the pin having been inserted in the groove near the 

 point is brought into position by withdrawing the director. Pins 

 are passed at some distance from the edges of the wound, and a 

 thread wound around the free ends in a figure-of-8. Where several 

 pins are inserted in series one thread may be used for securing the 

 whole, as in Fig. 144 ; in other cases a separate thread is employed 

 for each. When secured the points of the pins are removed with 

 cutting pliers. In removing pin sutures the margins of the wound 



