SUTURING 



10$ 



they act as infection carriers, putridity of the sutured trauma 

 is inevitable. 



2. Especial pains must be taken with each part of the 

 wound to bring the edges into neat apposition. As each 

 stitch or each par.t of the suture is being fixed, care must be 

 exercised to prevent infolding the skin. The skin edges 

 should be "heaped up" rather than infolded, because union 

 of the horny layer of the skin will never occur. (Figs. 64-223.) 



3. Whenever tension is required to bring a breach into 

 apposition, primary union is very unlikely to occur ; the 

 stitches will soften the tissues incarcerated in the loop and 

 will loOsen in a few days. Sometimes mattress sutures or 

 button sutures, placed some distance from the edges, may be 

 inserted to forestall tension at the edges, and at other times 

 lateral incisions (Cherry's operation) may be made to ad- 



FiG. 62— Quilled Suture. 



Fig. 63— Pin Suture. 



vantage. It is, however, generally preferable to treat trau- 

 mas as open wounds whenever for any cause great tension 

 is required to bring the edges together. 



4. The recommendation, mentioned elsewhere, to thread 

 a number of needles with short threads just sufficient for one 

 or two stitches, while preparing for an operation, will bear 

 frequent repetition in view of its significance. The thread 

 of a needle threaded with a strand long enough for a number 

 of stitches too frequently becomes contaminated with filth 

 from handling; from coming unavoidably in contact with 

 dirty parts of the patient, operating table or bedding; and 

 from being drawn so frequently through the skin or other 

 wounded tissues. In fact, a long strand of thread used to 

 suture any ordinary wound is sure to become unsafe before 

 it is entirely consumed, while short strands, inserted one 

 after another on separate needles, or even carefully threaded 



