. Manual of operative surgery. When a large defect in the abdominal wall cannot be closed in the abovemanner or in some modification thereof, closure has been effected by means ofa perforated celluloid plate (McCosh) or of a silver wire meshwork (Phelps, 620 HERNIA Willy Meyer, Bartlett). Meyer and A. E. Barker are very urgent in the praiseof this method of closure. The meshwork or fence of silver wire seems to bewell borne In the tissues and to form the nucleus of a strong mass of connectivetissue. The author has used Bartletts wire mesh with great satisfaction in a caseof hernia resulting fr
. Manual of operative surgery. When a large defect in the abdominal wall cannot be closed in the abovemanner or in some modification thereof, closure has been effected by means ofa perforated celluloid plate (McCosh) or of a silver wire meshwork (Phelps, 620 HERNIA Willy Meyer, Bartlett). Meyer and A. E. Barker are very urgent in the praiseof this method of closure. The meshwork or fence of silver wire seems to bewell borne In the tissues and to form the nucleus of a strong mass of connectivetissue. The author has used Bartletts wire mesh with great satisfaction in a caseof hernia resulting from loss of much of the upper end of the right rectus ab-dominis muscle. Kirschners plan (p. 614) of the free transplantation of aflap of fascia lata may possibly supplant the use of foreign materials. Ventral herniae of all varieties are to be treated on the same principles asare advocated for umbilical herniae. Undoubtedly the best treatment for post-operative ventral herniae is, to use an Irishism, not to have them. For this. Fig. 764.—Umbilical hernia. (Kelly.) purpose nothing is better than attention to cleanliness, careful closure of theparietes in their anatomic layers, and absolute avoidance of strain until theembryonic tissues necessary for the repair of abdominal wounds have had timeto become mature. Rutherford Morisons Operation.—(i) Make long transverse incisions in-cluding the hernia in an ellipse. (2) Expose the rectus sheath above, below andon each side of the hernia. (3) Open the sac and the abdomen through thelinea alba below the hernia. (4) Reduce the hernial contents, never cuttingaway omentum unless absolutely necessary. Cut away sac. (5) With fingersin the abdomen introduce thick catgut mattress sutures through the aponeurosisand rectus muscle on either side but do not tighten them. Separate and holdup the mattress sutures so as to expose the peritoneal wound. Suture the peri-toneal wound. Infold the aponeurosis by tightening and tying the mattresssuture
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