112 



BOWEL SUTURES. 



on account of the' continuous secretion, and that the parts 

 to bring together are the muscular and serous coats, the latter of 

 which shows a great readiness to adhere and unite. Sutures must 

 also ensure perfect closure of the bowel wound and absolutely prevent 

 bowel contents exuding. They should, therefore, be inserted about 

 every one eighth of an inch. On account of the thinness of the 

 walls slender needles are necessary. Special fine curved needles 

 or fine sewing needles can be employed. Aseptic silk is probably 

 the best sewing material ; catgut is less adapted for the purpose, 

 as it is sometimes too rapidly absorbed, the sutures yielding before 

 the union of the surfaces has occurred. To prevent this, catgut 

 rendered more resistant by the action of chromic acid has been intro- 

 duced, but boiled silk has no such disadvantage and serves every 

 purpose. 



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Fig. 147. — Interrupted sutures combined J 

 with sutures of relaxation. 





W_^ -H-. 



Fig. 148. — Tension 

 position. 



The first and simplest form of suture was Jobert's. The needle 

 was first passed through the serosa at some distance from the wound, 

 penetrated the entire thickness of the bowel, and emerged close to 

 the free border of the wound. The opposite lip of the wound was 

 transfixed in a similar way. The ends were then knotted together 

 and cut off (Fig. 149). This suture brought the serous coats into 

 apposition, as shown in Fig. 150, but had the disadvantage that 

 the threads passed through the lumen of the bowel, and might thus 

 convey septic material from it into the peritoneal cavity, producing 

 infection and inflammation in the track of the suture, resulting later 

 in peritonitis. 



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

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

 penetrate the mucous membrane, only extending to the muscular 

 or submucous coat (Fig. 151). 



