A system of practical surgery / by William Fergusson.

  • William Fergusson
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / by William Fergusson. Source: Wellcome Collection.

    80/878 (page 56)
    in many instances, it is doubtful if they are of much service after the first eight-and-forty hours; they are generally, therefore, removed on the second or third day from their introduction, but there need be no fixed rule for the practice, as the surgeon should allow himself to be guided by circumstances, and use his own discretion as to the proper period: indeed, within these few years so much have I become impressed with the advantage of stitches, more especially in the treatment of stumps and large cutaneous wounds, that I frequently permit them to remain until detached from one side of the newly- formed cicatrix by ulceration. When they are to be removed, the knot should be seized with the dissecting forceps, gently turned aside, and the point of one blade of the surgical scissors insinuated under the thread, which should then be divided, and withdrawn through one of the apertures. The method of treating a wound by means of stitches, for the purpose of encouraging early union, will be further illus- trated in describing the treatment of stumps immediately after ampu- tation. In many instances a bandage is not at all necessary when stitches have been applied; and wherever it can be dispensed with, it will be better to do so, as, in my opinion, the dressing upon a wound intended to heal by immediate union, cannot be too light and simple, but when- ever from the shape or weight of the parts there is a risk that they may fall asunder, the bandage had best be used. A small bit of lint covered with some simple ointment may be laid along the surface over the stitches; or the lint may be moistened with water and covered with oiled silk; but even these may, in many instances, be dispensed with. Occasionally it is of seeming advantage to keep the surface cool and moist, with a continued small stream of cold or iced water, which may be made to trickle along a bandage or strip of lint, having one end in a basin close at hand, and the other over the wound or dressings. The twisted suture (fig. 53) is often applied with great advantage in instances when it is requisite to keep the parts very steady, and in particular when some considerable stretch- ing of the neighbouring textures is neces- sary ; as, for example, in the operation for hare-lip. In some cases of this malforma- tion, the interrupted suture will serve to keep the cut surfaces of the lip together; but, in general, the drag upon the threads would be so great in the seat of each stitch, that ulceration would be almost certain to come on; and, supposing the edges of the wound did not separate, much pain and trouble, to say nothing of the unseemly scars that would follow, would be the inevitable result. The twisted suture is, therefore, highly advisable in all such instances; and con- sidering the extent of parts kept steady by the needle and thread, it