. Manual of operative surgery. eeding and preventscontamination of the next or essential row of sutures by the intestinal contents. Step 2.—At the mesenteric attachment introduce a Mitchell-Hunner mes-enteric mattress suture (Fig. 561), involving the serous, muscular, and sub-mucous tunics. To secure serous apposition at the mesenteric space there isno suture comparable to the above. The suture shown in Fig. 562 is lessdesirable. 27 4i8 OPERATIONS ON THE INTESTINES Step 3.—Introduce a Lembert suture at the free margin of the gut oppositethe mesenteric attachment. Introduce a continuous Lembert
. Manual of operative surgery. eeding and preventscontamination of the next or essential row of sutures by the intestinal contents. Step 2.—At the mesenteric attachment introduce a Mitchell-Hunner mes-enteric mattress suture (Fig. 561), involving the serous, muscular, and sub-mucous tunics. To secure serous apposition at the mesenteric space there isno suture comparable to the above. The suture shown in Fig. 562 is lessdesirable. 27 4i8 OPERATIONS ON THE INTESTINES Step 3.—Introduce a Lembert suture at the free margin of the gut oppositethe mesenteric attachment. Introduce a continuous Lembert suture allaround the gut. Each stitch should pick up about inch of the serousand subjacent muscular tunics. Do not pull the stitches very tight; allthat is required is that serous coat should be kept in touch with serous coat (Fig- 563)- Step 4.—Review the wound. Where advisable reinforce the line of unionwith Lembert sutures. Beware, however, of causing too much invaginationof the wound and thus producing Fig. 561.—Mitchell-Hunner stitch. The late Dr. Chas. T. Parkes made use of the continuous Lembert suturein the manner described, but omitted the provisional suture which penetratesall the coats of the gut. Parkes writes, apropos of his experimental work:The greatest number of mishaps followed drawing the sutures too tightly,which, if done, leads to death of the applied edges, and, of course, to failureThey must be drawn only sufficiently close to bring the surfaces fairly in con-tact; the subsequent swelling from obstructed circulation will hold the sur-
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