In dealing with superficial wounds, or with those to which pressure may be applied, the edges, after being brought accurately together, are secured by one or another of the several forms of suture, according to the character of the wound.
It is important in inserting stitches that they be made to take a good hold, to guard against tearing out. For this purpose they should be passed through the skin at least half an inch from the wound on one side, and brought out a similar distance from it on the other. If interrupted stitches are used they must be placed from half an inch to an inch apart. The edges must be perfectly level one with the other, so that folding or puckering of the skin may be avoided. In order to assure this, the edges should be brought into apposition and the points marked through which the sutures are to pass, or the edges should be held together by an assistant. The stitches must not be tied until all have been inserted, and then care must be taken not to draw them tighter than is necessary to bring the lips of the wound together. Overdrawn sutures obstruct the circulation of the tissues through which they pass, and excite irritation in the part, and interfere with the healing process.
Where a bandage can be applied over the dressing, its employment is most desirable, and in some cases it is indispensable to a speedy reunion of the wound. By careful adjustment it should be made to exercise gentle and uniform pressure on the divided parts, and by so doing keep them in close apposition, thereby preventing the accumulation of effused fluid, and favouring the healing by the first intention.
In those cases where bandages cannot be applied with effect, and especially in the case of large wounds inflicted on parts of the body where the detached skin and flesh has a tendency to become displaced by its own weight, deep stitches of stout flexible wire or catgut should be inserted (stitches of relaxation) at some distance from the edges of the wound, in order to remove any strain or undue tension from those uniting the edges of the wound (stitches of coaptation).
Fig. 418. - Curved Suture Needle with Eye at Point.