BOWEL STTTURES. 



Ill 



small rolls of gauze or tufts of cotton wool are employed for each 

 complete suture, allowing one to be removed without disturbing 

 the rest (Fig. 147). As, however, these become hard when saturated 

 with blood or discharge, they may advantageously be replaced with 

 small pieces of disinfected rubber tube, which can easily be cleaned, 

 and which yield slightly 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. 146. 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 sutures. 



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Fig. 145.— Ordinary deeply 

 placed interrupted sutures 

 used as sutures of relaxation. 



Fig. 146. — So-called "quilled" suture. 



Another form of tension suture is shown in Fig. 148. The free 

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

 light 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, buttons, 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 bowel many com- 

 plicated methods have been proposed, some of which certainly were 

 of value in pre-aseptic days, but are now discarded. Possessing 

 as we do suture materials which may safely be abandoned in the 

 abdominal cavity without setting up suppuration, peritonitis, etc., 

 many special precautions are now unnecessary. The sutures here- 

 after 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 



