SUTURES. 147 



the retention of breaches of continuity, whether the sewing be 

 done by means of Hnen or silk thread, animal fibre, metallic wire, 

 needles, j)ins or other instruments. By no other means can the 

 parts be held in the necessary coaptation to insure a perfect 

 reunion. The sutvire is available for various purposes. Besides 

 contributing materially to the coaptation of the edges of a wound, 

 and thus aiding to secure a cicatrization by first intention, it pre- 

 vents the contact and introduction of air into a wound, arrests 

 and prevents hemorrhage, keeps in place lacerated fragments of 

 deep wounds which could not be controlled by bandages alone, 

 assists in the closure of artificial openings, such as may take place 

 in the walls of the abdominal cavity, and prevents the escajDC of 

 any portion of its contents, and assists in the closing of natural 

 openings. But, though principally useful in efltecting the objects 

 enumerated, the essential indication of the suture appears in the re- 

 union of solutions of continmty, and, particularly, in regions where 

 the natiu-al movements of the parts tend necessarily to prevent 

 the borders of the wound from remaining in undisturbed contact, 

 for a period sufficient to obviate the danger of serious blemishes 

 of cicatrization. But while the suture is of no less advantage in 

 fresh injuries, it is also indicated as well in suppurating wounds, 

 with the precaution of leaving room for the free escape of j^atho- 

 logical secretions. 



Sutures are contra-indicated, when a wound becomes the seat 

 of extensive inflammation, or occupies a broad surface, or is ir- 

 regular, or accompanied by loss of tissue ; or when the parts are 

 the seat of severe contusion, or contain foreign bodies or mortified 

 tissues in their depths. There are other cases also, where their 

 employment is contra-indicated, as when their object is likely to 

 be defeated by the uncontrollable movements of the patient. 

 Causes of failure may also sometimes be found in the irritation 

 arising from the material of which the suture is formed, cutting 

 its way loose. By this accident, a wound which, if not interfered 

 with, would have left but little if any cicatrix, and would have 

 required but a short time to heal, becomes transformed into a 

 large, ugly, granulating surface, that is likely to leave a compara- 

 tively bad looking cicatrix in the end. 



The application of these retentive stitches falls under the 

 general rules relating to the disjiosltlon of the edges of the wound, 

 and the special placing of sutures. In reference to the first point, 



