Suture (anatomy)

“ SUTURE. (Sutura, lat.) A seam, stitch, joining together. Applied particularly to the line which marks the joining of the whorls of the spire. The suture is distinguished as simple, as in most cases; or double, when accompanied by a parallel groove close to it; marginated, when produced into a ledge by the matter which fills up and covers it; obsolete, when it is filled up so as not to be visible, as in the case of Ancillaria.
SYLVICOLA. Humph. Cyclostoma, Lam. ”

“ The skull has sutures: one, of circular form, in the case of women; in the case of men, as a general rule, three meeting at a point. Instances have been known of a man's skull devoid of suture altogether. ”

“ Suttee′ism, the practice of self-immolation among Hindu widows. [Sans. satí, a true wife.]
Suttle, sut′l, adj. light. [Subtle.]
Suture, sū′tūr, n. the mode of connection between the various bones of the cranium and face—serrated, when formed by the union of two edges of bone with projections and indentations fitting into one another—squamous, when formed by the overlapping of the bevelled edges of two contiguous bones: (surg.) the sewing up of a wound by one or other mode, so as to maintain the opposed surfaces in contact: (bot.) the seam at the union of two margins in a plant.—adj. ”

“ The wound cavity itself is now closed by several rows of buried sutures, so arranged as to bring together the 156edges of the several layers, tissue to like tissue. In congenital cases he does not loosen the sac, but sutures its opposing surfaces down to the point where the testicle lies free. The wound of the skin is now closed by a continuous silk suture, and an iodoform and collodion mixture brushed over the line of suturing until it is perfectly covered in and blood no longer oozes through. No drain is used, and no further dressing is deemed necessary. ”

“ If deeper structure than the skin be involved, the diseased area should be carefully removed even to the limitation of the buccal mucous membrane, the soft parts detached from the mucous membrane to render them mobile, and the wound brought together by suture. Care must be exercised so that the tension of the suture does not create a new deformity, such as blepharal ectropium, distortion of the rima oris or the alæ of the nose. ”

“ In thinking over this striking difference between the effects of the two kinds of suture, it seemed to me clear that it depended on the silk imbibing blood and serum, which, undergoing decomposition in its interstices, grew more irritating the longer the process continued; whereas the metal gave no hold to the organic liquids, which were shed unaltered as fast as they were effused. From these and other analogous considerations, I taught my class at that time that decomposition of the organic liquids was the essential cause of suppuration. ”

“ A fracture produced in adult life is generally recognizable as such; but a fracture dating from earlier stages of life, produced before the growth of the bone has ceased, may, if not entirely obliterated, present more or less the characteristics of a suture. I have seen several skulls where a division in the parietal bone or the temporal squama presented at the same time features of a fracture and suture ”

“ The accompanying illustrations well indicate this arrangement of sutures and teeth (Figs. 26 and 27) ; the importance of these facts will be emphasized later. All traces of the facial aspect of these sutures disappear quite early in life.
Figs. 26 and 27.—Diagrams to represent the normal human upper jaw of a child, with four and six incisors respectively, and also indicating the five intermaxillary sutures. (After Albrecht.)
EG, MG, XG. Endo-, meso-, and exo-gnathion. e. Inter-endognathic suture. f. Endo-mesognathic suture. g. Exo-mesognathic suture. i1. Central incisor. i2. Lateral incisor. ”

“ The course of the frontal suture is indicated externally by a slight ridge; and where it joins the coronal, this ridge rises into a small protuberance. The course of the sagittal suture is grooved, and above the angle of the occipital bone the parietals are depressed. ”

“ A long straight needle with a spear-point is convenient for introducing the mass-suture. A gauze sponge should be placed beneath the incision as the sutures are introduced, to prevent injury of the intestines and the escape of blood into the peritoneum. When the pad is removed, the omentum, if readily found, should be drawn down behind the incision. Before each suture is secured the sides of the incision should be drawn forward by traction on the ends of the suture, to ensure accurate apposition upon the posterior or peritoneal aspect. ”

“ At the same time, it is not uncommon, especially in children, for a suture to be sprung by violence applied to the head, or for a fissured fracture to enter a suture and, after running in it for some distance, to leave it again. The edges of a clean cut in the periosteum may be mistaken for a fissure in the bone, especially if reliance is placed on the probe for diagnosis. ”

“ At first he settled down to practice in Montgomery, Alabama, devoting himself mainly to the diseases of women. He had for some two years used the clamp suture of Marion Sims in vesico-vaginal fistula, but became convinced that this and the usual methods were at fault. He pondered deeply on the subject for some seven weeks and discovered one day while buttoning his vest that something similar to a button might be combined with the old interrupted suture with its independent action, and the "button suture" was the outcome. After this Bozeman had 100 per cent, of cures instead of twenty-five. ”

“ If the suture is made too tight the subsequent swelling may cause the stitch to tear out. In order to make a firm suture the depth of the stitch should be the same as the distance the stitch is from the edge of the wound. The deeper the suture the more tissue is embraced and the fewer the number of stitches required. In tying a suture the square or reef knot should be used. Closure of wounds by means of adhesive plaster, collodion, and metal clamps is not practiced to any great extent in veterinary practice. ”

“ Although the employment of buried sutures has made abdominal incisions more secure in the process of healing, and renders them firmer after union, and thus reduces the chances of a yielding scar, and saves the patient the inconvenience of an abdominal hernia or the annoyance of wearing an abdominal belt, it renders the patient liable to another discomfort, namely, stitch-abscess. This complication arises from a variety of causes—for example, imperfect sterilization of the suture material, or of the patient’s skin preceding the operation. ”

“ When hysteropexy is needed for a large, bulky, and prolapsed uterus, the steps of the operation are the same as for retroflexion, but it is necessary to introduce a greater number of retaining sutures. Further, as the uterus tends to slip downward into the vagina, it is an advantage, as soon as the fundus of the uterus is drawn into the wound, to transfix it with a stout suture, in order that the assistant may use it as a tether to keep the uterus in position whilst the surgeon introduces the main sutures. ”

“ The sutures between the dorsal (notal) pieces are frequently obliterated in the workers, while they are distinct in the males and females, and the pieces themselves are also much larger in size in these sexed individuals. The pro-mesothoracic stigma is apparently always distinct; the meso-metathoracic one is distinct in the male Dorylus, but can scarcely be detected in the winged forms of other ants, owing to its being enclosed within, and covered by, the suture between the two segments: in the workers, however, it is usually quite conspicuous. ”

“ About two-thirds of the way back the sagittal suture becomes less serrated and on each side of it the small parietal foramen may be seen. This only transmits a small emissary vein (see Veins) in the adult, but, as will be seen later, is of considerable morphological interest. As middle life is reached the cranial sutures tend to become obliterated and the bones can no longer be separated; this fusion begins at the places, where the sutures are least deeply serrated, and as a rule the sagittal suture disappears between the two parietal foramina between thirty and forty years of age. ”

“ Gruber describes one such case [12] as an instance of an oblique parietal suture, while Hyrtl and Ranke both consider this case as one with an acquired division. [Pg 291] To differentiate a congenital real oblique suture from a division which is the result of a fracture, we must be guided largely by the situation, form, and serration of the division, and the condition of the surrounding bones, especially that of the opposite parietal. ”

“ Muscular parts are to be brought into apposition, and so retained principally by position, aided by a continuous suture through the integuments only, together with long strips of adhesive plaster, moderate compression, and sometimes a retaining bandage.
7. Sutures should never be inserted through the whole wall of the abdomen, and their use in muscular parts under any circumstances is forbidden; unless the wound, from its very great extent, cannot be otherwise sufficiently approximated to restrain the protrusion of the contents of the cavity. The occurrence of such a case is very rare. ”

“ Sutures, like ligatures, were a common cause of suppuration in or around the edges of the wound. Therefore, in the hope of avoiding this trouble, they were made of silver wire, which was inconvenient to handle, and gave pain at the time of removal of the sutures. At the present time they are of silkworm-gut, catgut, silk or horsehair; they are made aseptic by boiling, and can be left any number of days without causing suppuration and can then be removed without pain. Next may come the consideration of surgical dressings. ”

“ But since many who suffer from the irritation of the ciliary hairs are not able to endure even the name of the operation by suture, we are compelled from necessity, against our will, to have recourse to burning by medicine. ”

“ When the wound is extensive, as when a considerable part of the cheek is involved, approximation may be accomplished by a few points of interrupted suture, and afterwards the parts may be more securely and accurately fixed by convoluted sutures placed between the interrupted. ”

“ The secondary deformity of the ear is brought together by suture. The author has found that this cannot be readily done without puckering the rim when the line of excision is made convexly, and advises making it triangular instead. The defect of the nose should be freshened to the same form. The flap from the ear now becomes ideal, fits better, is more readily sutured in place. No sutures should, however, be made through the apex of this triangular flap to avoid gangrene at this frail point. Silk isinglass at this point acts as a splint. Dry aristol dressings are used.
Fig. 453.—König Method. ”

“ Skull.—Difference in occipitonasal length and zygomatic breadth, both having low coefficients of variation, are useful in separating species, especially where they are sympatric. Shape of presphenoid, nasals, interparietal, frontoparietal sutures, and length and degree of the openings of the incisive foramina are useful in delimiting subspecies. The rostrum of B. taylori, in front of the frontonasal suture, is deflected three to five degrees ventrally in 85 per cent of [Pg 601] the adults examined, and in B. musculus is less, or not at all, deflected. ”

“ Complete [79] maceration of the skull is always essential in endeavouring to estimate in what way the various sutures of the skull influence the extent and direction of a fracture. Sutural separation is generally regarded as of infrequent occurrence. An examination of a large number of macerated skulls has shown, however, that sutural separation is in reality of common occurrence. Certain sutures show a special liability to such changes, especially the masto-occipital, the petro-occipital, and the petro-sphenoidal. Separation of the sutures is more common in the young adult ”

“ Into its formation several bones enter; in the adult skull one usually sees posteriorly a cruciform suture indicating the limits of the superior maxillæ and palate bones; but even in the adult, evidence is forthcoming in the existence of traces of sutures to indicate that the anterior part of the palate is formed independently of the part immediately behind it. ”

“ Three criteria of adulthood are: (a) suture obliterated between supraoccipital and exoccipital, (b) suture at least partly obliterated between basisphenoid and basioccipital, (c) supraorbital crests not widely separated and almost parallel. In males the crests encroach on the lateral borders of the interparietal; in females the crests approach the lateral borders of the interparietal but are more widely separated than in males. ”

“ Sutures generally quite, or almost quite obliterated; but when well preserved, they differ remarkably in appearance from those in the foregoing species; for the radii externally here consist of oblique plates or laminæ arising on both sides of the sutures, standing nearly parallel to the parietes, and interfolding with each other. These laminæ are rather plainly marked by lines of growth. Essentially the radii do not differ much from those in C. dentatus and Hembeli; we have but to produce obliquely upwards the transverse and interlocking ribs on their radii, and so convert them into laminæ. ”

“ The dentary bone appears to have been attached by suture to the articular and angular, as its free margin has very much of the outline of that suture in Amphiuma and lizards. The coronoid process would also seem to be a part of the same bone as in Amphiuma and Menopema, and not composed of the coronoid bone as in lizards. It rises immediately behind the last tooth, and displays no suture. ”