SUTURING 



105 



This simple suture is inserted by picking up first one edge 

 and then the other with the dissecting forceps as the needle 

 held in the other hand is pushed through the integument from 

 without inward on the first side and from within outward on 

 the other. The stitches may all be placed one after another 

 along the whole wound before tying any one of them, or else 

 they may be tied as fast as they are placed. The latter course 

 is. preferable in all large or irregular wounds, in the interest 



56 — Combined Button and Interrupted Sutures. 



of exactness. When primary union is of capital importance 

 the needle should be made to penetrate from within outward 

 only through both edges so as to forestall the carrying of 

 infection from the outer layers of the skin into the subcutem. 

 This course necessitates the re-threading of the .needle for 

 each penetration, but the additional trouble is worth while 

 under certain circumstances, especially when sewing an un- 

 shaved skin where hairs are liable to be inverted into the 

 needle tract by the thread. 



p*-i. 



o 

 \ 





p IG 57— Combined Mattress and Continuous Sutures. 

 a, a, a— Mattress Sutures, b— Continuous Suture. 



The continuous suture is made by a simple sewing proc- 

 ess after the thread has been knotted at. the end. to prevent 

 slipping through the first perforation. (Figs. 54-55-) This su- 

 ture is particularly desirable where the rapid closure of a 

 wound is essential, or where the only object is the temporary 

 retention of dressings in the traumatic cavity. 



Mattress Sutures and Button Sutures.— Each of these is 

 but a slight modification of the other. Both of them are 



