OCR Text |
Show or SUTURES. 0F SUTURES. OF THE USE OF THE NEEDLE IN FLESH WOUNDS. UNDER this head I have only to say, that the needle and it gature is by many surgeons used on every trifling occasion, and quite needlessly. In a wound that might have been cur-i ed with great ease, by an adhesive strap, or the uniting 41 It is by this means that we avoid the filling of the deep part of the. wound with blood. Notwithstanding the arguments for the vitality of the blood (and these I am far from contradicting),- the fact is, that by negligently allowing the blood to lodge in the wound, we shall afterwards have suppuration. In wounds, as in ulcers, it will be often essentially necessary bandage, I have seen the surgeon very alert with his needle, that we support them by an elastic roller. This is quite wrong, and exposes the surgeon to a very unpleasant imputation: it is making a surgical case out of no- sure irritates ; and I have seen it when very great, as in the attempt to suppress the haemorrhagy, produce gangrene in the thing. wound. If there be a cut in a fleshy part of a limb, still there is no necessity for bringing it together by ligatures. If the cut is When we wish the lips of the wound to heal, so that there shall be no unsightly scar or contraction, all depends upon with the fibre of the muscle, the wound will not gape; if it be made across the muscular fibre, it is best managed by bring- we must be careful that they be not turned inward. ing the limb into a position of ease, and relaxing the muscle. the operation, we must keep the parts very dry, and promote But much pres- the neatness with which the edges are brought together ; and After l Paris on which you can apply the compress and bandage, as l . I'm," a MIMI}. MUM . A against flat bones, seldom require the needle and ligature. In loose and moveable parts, as in the cheek and lips, ligatures or the twisted suture are absolutely required. In the ~ .-t.‘..~.w+:reu\«-"‘ belly, too, the suture is absolutely necessary. But in the scalp, if possible (and I believe it is always possible), the needle is to be avoided; the uniting bandage, and soft elastic compress, answering every purpose, when the hair growing from the scalp has made it diiiicult to bring the wound together by the adhesive straps. the formation of a scab by the oozing of the secretion. If there is a little fretting, we may pick and lift a part of the scab, to allow the collected matter to flow, and squeezing the wound gently, evacuate it, rather than by this accident lose all our hopes of union. When a fretting erysipelatous inflammation is on the lips of the wound, by cutting the ligatures in time, and removing their irritation, still however supporting the parts, we may save the wound from bursting entirely up. When this fails, suppuration must be promoted by fomentation and poultices, Alter operations with a. loss of skin, much advantage may be gained by one or two strong ligatures. But let them be well supported by adhesive straps. By this means, what would probably degenerate into an extensive suppurating sore, and the parts brought together again, after kindly suppuration may be made to adhere by the first intention ; or at least the much in bed, or to live in a confined room, but move him open surface may be much diminished. about, if the circumstances of the case will allow. When the needle and ligature is used to draw the lips of wounds together, we make the interrupted suture. If we do not support the integuments from cutting upon the ligature. by adhesive straps in the intervals, we must do it by laying r-nupresses on the sides of the wound, and over these applying the roller or bandage. is established. In the hopes of procuring adhesion, and indeed in the treatment of all wounds, we ought not to allow the patient to lie Free air, simple diet, and a correct state of the bowels, are absolute- ly indispensable. VOL. I. |