114 TENDON AND NERVE SUTURES* 



closed by inserting closely placed sutures of fine silk. In exceptional 

 cases the continuity of a severed artery may be preserved by adopting 

 Murphy's method of invaginating the central end within the peripheral 

 end of the vessel and securing the parts with fine silk sutures. 



Tendon Sutures. In man recently ruptured tendons are united 

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

 such case the cut ends are drawn together by three or four strong 

 sutures passed through the substance of the tendon, and the divided 

 sheath, if not too much lacerated, is closed by fine catgut sutures. 

 The external wound is then dressed and bandaged in the usual way. 

 In one method the needle is inserted about a quarter of an inch from 

 the cut 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 may 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 tendons to a considerable distance. The divided ends 

 may, however, often be gradually approximated by inserting sutures, 

 applying a dressing, and fixing the limb as far as possible with splints 

 and plaster bandages. In small animals union of a ruptured tendon 

 may be readily effected by sutures and by securing the limb in a 

 position which will prevent undue tension of the sutured tendon. 

 In cases associated with loss of tendon substance or where the space 

 between the ends is too large to permit of their immediate 

 appoximation, the gap is sometimes bridged by incising one end of 

 the tendon to form a flap, which is attached to the other end by 

 sutures. In horses and cattle ruptured flexor tendons are seldom 

 sutured, but severed extensor tendons can be successfully treated 

 by suturing and the application of splints or a plaster bandage to 

 the limb. 



Nerve Sutures. In suturing divided nerves fine sewing needles 

 are required. The edges of the cut nerve sheath are brought together 

 by a number of closely placed stitches, and one or two sutures may 

 be passed through the nerve trunk. Immediate contact of the cut 

 ends is desirable, though not always possible without traction on 

 the nerve. But even where the ends, after suturing, are separated 

 by a space of half an inch, repair will follow and there need be little 

 fear of permanent loss of function. As suppuration is the chief 

 cause of imperfect repair of wounded nerves aseptic precautions 

 should be scrupulously observed throughout the operation. 



