WHEN a Wound is recent, and the Parts of it are divided by a sharp Instrument, without any farther Violence, and in such a manner that they may be made to approach each other, by being returned with the Hands they will, if held in close Contact for some Time, reunite by Inoculation, and cement like one Branch of a Tree ingrafted on another. To maintain them in this Situation, several sorts of Sutures have been invented, and formerly practised, but the Number of them has of late been very much reduced. Those now chiefly described, are the interrupted, the Glover's, the quilled, the twisted, and the dry Sutures; but the interrupted and twisted, are almost the only useful one's; for the quilled Suture is never preferable to the interrupted; the dry Suture is ridiculous in terms, since it is only a Piece of Plaister applied in many different Ways to re-unite the Lips of a Wound; and the Glover's, or uninterrupted Stitch, which is advised in superficial Wounds, to prevent the Deformity of a Scar, does rather, by the Frequency of the Stitches, occasion it, and is therefore to be rejected in favour of a compress and sticking Plaister; the only Instance where I would recommend it, is in a Wound of the Intestine: the Manner of making this Suture I shall describe in the Chapter of Gastroraphy.
From the Description I have given of the State of a Wound proper to be sewed up, it may be readily conceived, that Wounds are not fit Subjects for Suture, when there is either a Contusion, Laceration, Loss of Substance, great Inflammation, Difficulty of bringing the Lips into Apposition, or some extraneous Body insinuated into them; tho' sometimes a lacerated Wound may be assisted with one or two Stitches. It has formerly been forbidden to sew up Wounds of the Head; but this Precaution is very little regarded by the Moderns; though the ill Effects I have frequently seen from Matter pent up under the Scalp, and the great Convenience there is of using Bandage on the Head, have convinced me, that much less Harm would be done, if Sutures were used in this Part with more Caution.
If we stitch up a Wound that has none of these Obstacles, we always employ the interrupted Suture, passing the Needle two, three, or four Times in Proportion to the Length of it, though there can seldom be more than three Stitches required.
The Method of doing it is this: the Wound being emptied of the grumous Blood, and your Assistant having brought the Lips of it together, that they may lie quite even; you carefully carry your Needle from without, inwards to the Bottom, and so on from within, outwards; using the Caution of making the Puncture far enough from the Edge of the Wound, which will not only facilitate the passing the Ligature, but will also prevent it from eating through the Skin and Flesh; this Distance may be three or four tenths of an Inch: as many more Stitches as you shall make, will be only Repetitions of the same Process. The Threads being all passed, you begin tying them in the Middle of the Wound, though if the Lips are held carefully together all the while, as they should be, it will be of no great Consequence which is done first. The most useful Kind of Knot in large Wounds, is a single one first, over this, a little Linnen Compress, on which is to be made another single Knot, and then a Slip-knot, which may be loosened upon any Inflammation; but in small Wounds, there is no Danger from the double Knot alone, without any Compress to tie it upon; and this is most generally practised. If a violent Inflammation should succeed, loosening the Ligature only will not suffice; it must be cut through and drawn away, and the Wound be treated afterwards without any Suture. When the Wound is small, the less it is disturbed by dressing, the better; but in large ones, there will sometimes be a considerable Discharge, and if the Threads be not cautiously carried through the Bottom of it, Abscesses will frequently ensue from the Matter being pent up underneath and not finding Issue. If no Accident happen, you must, after the Lips are firmly agglutinated, take away the Ligatures, and dress the Orifices which they leave.
It must be remembered, that during the Cure, the Suture must be always assisted by the Application of Bandage, if possible, which is frequently of the greatest Importance; and that sort of Bandage with two Heads, and a slit in the Middle, which is by much the best, will in most Cases be found practicable. The twisted Suture being principally employed in the Hare-lip, I shall reserve its Description for the Chapter on that Head.