Suture

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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 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. ”

“ I shall begin, then, with Aristotle, the contemporary of our author, who, in his work “On the History of Animals,” gives the following very inaccurate description of the sutures of the human skull: “The female cranium has one circular suture, but men generally three, which unite in one point. But a male skull has been seen not having a suture.” [747] Celsus describes the sutures in the following terms: “Ex ceteris, quo suturæ pauciores sunt, eo capitis valetudo commodior est. ”

“ 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. ”

“ Having, therefore, made a lunated incision below the breast, and dissected away the skin, we unite the parts by sutures. But if, as in women, the breast incline downward, owing perhaps to its magnitude, we make in it two lunated incisions, meeting together at the extremities, so that the smaller may be comprehended by the larger, and dissecting away the intermediate skin, and removing the fat, we use sutures in like manner. But if, through mistake, we should cut away too little, we must again remove what is redundant, and apply the remedies for fresh wounds. ”

“ 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. ”

“ Author’s Method.
Before suturing the wounds, it is advisable to free the skin of the inferior lobule to overcome tension.
The sutures are applied as in Fig. 481. None are used to unite the mucosa unless the interior wounds are large enough to permit of their use. ”

“ Greatest width 42⁄3 millim., smallest 4; height 31⁄2.
(44) Melania subgradata. (Plate XXXVII. fig. 3, 3 a) . Shell elongate, turreted, rather solid, covered with an (olive?) epidermis, and marked with fine longitudinal oblique red lines which extend from suture to suture. Whorls probably about 10, flat or even a little [350] concave at the sides, shouldered above, usually with a spiral shallow groove and a few striæ near the shoulder, and marked with fine incremental striæ. Suture deep, slightly oblique. Last whorl long, finely transversely striated, most distinctly at the base. ”

“ 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 ”

“ Sutures.—Twisted silk sutures are to be preferred, as they do not invite sepsis, as softening catgut does, and retain the parts during the entire time required for healing, while the latter is liable to become separated by uneven absorption, allowing the wound to gape at that point and causing more or less of a cicatrix, so intolerant to patients of this class.
Dressings.—Bulky bandages are not required; they heat the parts, and look unsightly. The author employs antiseptic adhesive silk plaster for covering all external wounds, except where the hair prevents its use. ”

“ 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 sutures are also discernible, but the complex disposition of their serrations, shown in the figure, is not obvious in the cast. Though the ridges which give attachment to Fig. 24.—The Engis skull viewed from above (A) and in front (B) . muscles are not excessively prominent, they are well marked, and taken together with the apparently well developed frontal sinuses, and the condition of the sutures, leave no doubt on my mind that the skull is that of an adult, if not middle-aged man. ”

“ Moreover, the author goes on to remark that in adult birds trace of the origin of the sternum from five centres of ossification is always more or less indicated by sutures, and that, though these sutures had been generally regarded as ridges for the attachment of the sternal muscles, they indeed mark the extreme points of the five primary bony pieces of the sternum. ”

“ In operations such as advancement, where sutures are used, it is desirable that the face should be covered with sterile muslin, with a hole cut in it for the eye, so as to prevent the sutures being contaminated from the skin of the face. The eyelids are again washed in 1–2,000 perchloride of mercury lotion, and the conjunctival sac is washed out with a strong stream of boric lotion or normal saline by means of a sterilized irrigator or an undine (Fig. 77) which has been kept in a bowl of lotion. ”

“ For the symptoms of the attendant catarrh of the sac see below. In infected cases with obstruction of the lachrymo-nasal duct, it has been known to extend to the bone and even to open into the sinuses, or tooth follicles. (Gerard, Leblanc) .
The condition is found in horses, cattle and dogs.
Treatment. In fistula resulting from simple traumatism, nothing more may be requisite than rest and soothing astringent applications. Sutures are sometimes resorted to but are liable to cause itching and do more harm than good. ”

“ After the douche the labia should be separated and the vagina carefully dried by cotton held in dressing-forceps. Except in those cases in which the sphincter ani is involved, the bowels may be moved on the second or third day. The woman should stay in bed for two weeks, at the end of which time the sutures should be removed. 67 She should avoid heavy lifting, long standing, and bicycle- or horseback-riding for two months after the operation. Constipation should always be avoided. Coitus may be resumed six weeks after operation. ”

“ The sutures in the skulls of young mammals have been advanced as a beautiful adaptation for aiding parturition, and no doubt they facilitate, or may be indispensable for this act; but as sutures occur in the skulls of young birds and reptiles, which have only to escape from a broken egg, we may infer that this structure has arisen from the laws of growth, and has been taken advantage of in the parturition of the higher animals. ”

“ Sutures generally distinct in young specimens, and nearly obliterated in full-grown individuals. Radii, when present, very narrow. The orifice of the shell, in full-grown specimens which have their summits a little worn, is narrow, much elongated, about twice as long as wide, oval or ovate, with the rostral end the narrowest: the elongation of the orifice offers almost the only character by which this species can be externally recognised. The lateral compartments are rather wider than usual in proportion to the rostro-lateral compartments. ”

“ The author has sought to obviate the first of these difficulties by the use of deep silver sutures instead of the superficial ones described by Emmet. They should be introduced before tightening the vaginal sutures, and should be passed far around in the posterior vaginal wall, their points of entrance and exit being the same as for the three lower unsecured superficial external sutures in Fig. 14. The second difficulty may be overcome by further denuding a triangular surface in the vaginal sulcus on each side, the base of the triangle corresponding [p. 165] to the line a b, Fig. ”

“ Occasionally the sutures are preserved, and then the four compartments are seen to be of nearly equal sizes. The orifice is always broadly oval, with the carinal end the broadest; and it often approaches closely to circular. The upper part of the shell is frequently steeply conical, with the lower part spreading and folded ”

“ The compartments are separated from each other by sutures, which are often so fine and close as to be distinguished with difficulty. The edge of a compartment, which can only be seen when disarticulated from its neighbour, I have called the sutural edge (acies suturalis) .
Each separate compartment consists of a wall (paries) , or parietal portion (pp in woodcuts) , which always grows downwards, and forms the basal margin; and is furnished on the two sides either with alæ (fig. 4) , or with radii (fig. 2) , or with an ala on one side and a radius (fig. 3) on the other. ”

“ The measuring is performed twice—in the first instance, to show that its sutures are separated by disease, or, to speak more plainly, that the bones of the head are absolutely opened, and that as a natural consequence the head must be much larger than when the patient is in a state of health. ”

“ Facial sutures at or near the margin, or ventral. Compound eyes absent. This is equivalent to Salter’s Agnostini and Ampycini with the addition of the Harpedidae.
2442. Opisthoparia. Facial sutures extending from the posterior margin to the front margin, but occasionally uniting in front of the glabella. Eyes holochroal or prismatic, but sometimes absent. This comprises the same families as Salter’s Asaphini with the exclusion of the Harpedidae and Calymenidae. ”