William Halsted, M.D. (1852-1922), was an innovative U.S. surgeon who introduced the fundamental surgical principles that bear his name. Halsted was one of the “Big Four” founding professors at the Johns Hopkins Hospital. Halsted had unique techniques, operated on the patients with great confidence and often had perfect results which astonished the interns. He was later called the Father of Modern Surgery. He developed multiple concepts and surgical procedures including;
The first cholecystostomies in the U.S. (It was done on his mother, reportedly on the kitchen table, at 2 a.m.), one of the first blood transfusions in the U.S. (He gave his blood to his sister, who had just delivered a baby), he emphasized hygiene and importance of asepsis, he investigated wound healing, he performed the first radical mastectomy for breast cancer, he introduced the surgical glove, made of thin rubber, he contributed to significant advances in thyroid, biliary, hernia, intestinal and arterial aneurysm surgeries, as one of the first proponents of hemostasis and investigators of wound healing, he was responsible for the inclusion of temperature charts in medical records.
Figure 1 Interrupted Halsted Suture
The Halsted suture can be performed both as an interrupted and running inverting suture, which is placed through the subcutaneous fascia and runs parallel to the wound. This creates an inverted edge formation and the ends are tied together. Practically, it is a modification of the Lembert suture (bkz. Lembert suture), which continue to the next leap with an additional circumferential link that supports the suture parallel to the wound.
The technique is practiced as followed (1-4 is same as Lembert Suture):
- The needle is placed perpendicular to the epidermis at a distance of about 8 mm from the edge of the wound.
- With precise wrist movements, the needle is rotated under the surface of the dermis and the needle tip is removed 2 mm far from the wound edge on the ipsilateral side of the skin.
- The needle penetrates the skin perpendicular to the skin 2 mm far from the opposite side of the wound without touching the incision.
- The needle is turned under the dermis surface and leaves the skin 8 mm far from the incision. Thus, the reverse of the transaction on the other side has repeated.
- The peripheral stitch was inserted under the skin and needle penetrated again with an extension of 6-8 mm from previous exit and steps 1-4 repeated.
- If the suture is to be made intermittently (Figure 1), it is gently knotted and cut therefore forms a rectangular shape. The process is repeated throughout the incision.
- If it is planned to be thrown continuously (Figure 2), the procedures 1-5 are repeated until the end of the wound, starting with the first entry point, and the wound is closed by throwing the knot.
- Care is taken to minimize tension throughout the epidermis and prevent excessive narrowing of the wound edges during knotting.
Figure 2 Running Halsted Suture