SUTURE, in Surgery, is the method of sewing together the edges of wounds ; and the term is also applied to the threads with which the operation is effected.
The only wounds in which the application of sutures can be bene ficial are those of which the edges, if held together, are likely to unite. They are therefore improper in all contused wounds, in the majority of Lacerations, and in those wounds which extend so deep that, though the superficial parts might be brought together, the deep ones would remain open. But in cleanly-cut wounds, whose edges can be placed and kept in contact without any painful stretching of the parts adjacent to them, sutures are, if applied with proper cautions, by far the most convenient and secure method of obtaining a speedy reunion.
The necessary cautions are, that they should not be allowed to remain in the wound till they excite acute inflammation, and that if from any cause the wound become inflamed, they should be at once removed. In general, thirty-six hours are sufficient for a wound through the skin and the superficial parts to unite so far that it does not need sutures to keep its edges in contact. After this time, there fore, the sutures should be removed ; and in cases of deeper wounds, and of amputations, it will not be necessary to retain them more than twenty-four hours longer.
The several kinds of suture employed in surgery are named the interrupted. the uninterrupted, and the twisted. In the first, the edges of the wound, having been duly cleaned, are brought together by several single stitches placed an inch or more part. A threaded curved needle is passed through the skin from one side of the wound to the other, so as to include about one-third of an inch of healthy skin on each aide of It, and then, the needle being cut off, the two ends of the thread are tied pretty firmly in a double knot over the line of the wound. This is repeated as many times as tho length of the wound requires, and the spaces between the successive sutures, where the edges of the wound usually gape a little, may be held together by sticking-plaster. The latter alone will suffice when the sutures arc
removed.
In the uninterrupted or glover's suture, a single thread is carried alternately from one side to the other along the whole length of the mound, the needle being in each stitch passed from the border of the mound towards the adjacent healthy skin. There are only two kinds sf eases in which this mode of suture can be usefully employed, namely—first, in certain wounds of the stomach and intestines, when those organs are to be returned into the abdomen, and it is of the highest importance that every part of the opening into them should be closed, so that their contents may not escape; and secondly, in ordinary ruts of the palm of the hand or the fingers, where, the outiele being thick, the uninterrupted suture may be made without pain.
The twisted suture is employed for wounds iu those parts of the skin which are very loose, and in which it is desirable to obtain a very exact union by the first intention, such as the lips, the eye lids, the cheeks, kc. Instead of threads, one or more pins are passed across the wound and through the adjacent skin ; and the edges of the former being brought together, are retained in their places by coils of silk wound like the figure 8 upon the projecting ends of the pins. This is the mode of suture commonly employed after the operation for hare-lip.
With all kinds of sutures it is of the highest import:me° that the dressings over them should be very light and cool. It is probably owing to the neglect of this caution, and of that already given respect ing the time during which they should be retained, that some surgeons have been led to regard sutures as more mischievous than beneficial, ascribing to them the injuries produced by the injudicious management of other parts of the treatment.