Suturing (Seevya) should be resorted to in the case of an open ulcer due to the action of the deranged fat after its vitiated contents (morbid matter) had been fully scraped out, as well as in the case of an uncomplicated (curable) Sadya-Vrana (wound or instant ulcer) at any of the joints which are connected with the acts of movement or locomotion.

Conditions Of Suturing

An nicer incidental to the application of fire (cautery), or any alkaline preparation (caustic), or treated with any poisonous drug or substance, or from whose inside the embedded Shalyam (foreign matter) has not been removed, should not be sewed up without being thoroughly cleansed and purified asepsised inasmuch as any foreign matter, whether a hair, nail or a particle of dust or bone, lying embedded in its cavity, might set up an abnormal suppuration, accompanied by extreme pain and excessive secretion. Hence such ulcers should be thoroughly cleansed (and all foreign or indigenous morbid matter should be extracted therefrom) before being sewed up.

Mode Of Suturing

Then having pressed the ulcer up into its proper position, it should be sutured with strings of any of the following kinds, viz. of thin cotton thread, of the fibres of the Ashman-taka tree or hemp plants, or of the Atasi, Murva or Guduchi, or with strips of leather, plaited horsehair or animal sinews, into any of the officinal shapes (of suturing) known as the Gophana, Tunna-Sevani and Riju-Granthi, etc. or as suited to the shape and position of the ulcerated part. The margin of the ulcer should be gently pressed close with the fingers during suturing. A round needle to the length of two fingers' width should be used in sewing up an ulcer occurring about any joint or in a part of the body where the flesh is thin and scanty. A needle of a triangular body (tri-hedral), and measuring three fingers' width in length, is recommended in the case of an ulcer appearing at any fleshy part of the body. A semi-circular or bow-shaped needle should be used in a case where the seat of the ulcer would be found to be on the scrotum, or on the skin of the abdomen, or about any of the Marmas (vital parts).

Needles of these three shapes should be so constructed as to be fitted with sharp points capable of being handled with the greatest ease, having a girth equal that of the stem of a Malati flower.

The needle should not be pricked into a part too near, or too remote from the fissure, or the mouth of an ulcer, as there might be the danger of the suture being broken off (at the least pressure or movement) in the first instance and of genesis of pain in the second. An ulcer, thus properly sutured, should be covered over with cotton and dusted over with a pulverised compound consisting of the powders of Priyangu, Anjanam, Yasthyahva and Rodhra, or with the ashes of a burnt piece of Kshauma cloth, or with the powders of the Shallaki fruit. Then the ulcer should be properly bandaged, and measures and rules regarding the regimen of diet, and conduct previously laid down in the chapter on the nursing of an ulcer-patient (Ch. XIX.) should be adopted and observed.

The eight kinds of surgical operations have thus been briefly described. They will be dealt with later on in the Chikitsitam.