. American practice of surgery ; a complete system of the science and art of surgery . , when the viscera or the protective sponge orpad is forced up against the needle point, the introduction of the bowl of aspoon to receive the needle aids materially the insertion of the sutures. If dis-tention is marked, relaxation sutures may be added. * The term intercuticular is very commonly employed by surgical writers, but intra-cuticular is evidently the more correct expression. VOL. VII.—9 130 AMERICAN PRACTICE OF SURGERY. Tier Suture. (Fig. 58.)—The tier or layer suture for closing the abdoininalwo
. American practice of surgery ; a complete system of the science and art of surgery . , when the viscera or the protective sponge orpad is forced up against the needle point, the introduction of the bowl of aspoon to receive the needle aids materially the insertion of the sutures. If dis-tention is marked, relaxation sutures may be added. * The term intercuticular is very commonly employed by surgical writers, but intra-cuticular is evidently the more correct expression. VOL. VII.—9 130 AMERICAN PRACTICE OF SURGERY. Tier Suture. (Fig. 58.)—The tier or layer suture for closing the abdoininalwound is the one of choice. By this method the several layers of the abdominalwall are united separately, and the union of like tissues in their natural orderconstitutes an ideal method of procedure. Furthermore, hei-nia undoubtedlyoccurs less frequently since this manner of approximating the edges of the woundhas been adopted. The tier suture may include as many as four layers or tiers. For example,the first set of sutures—continuous or interrupted catgut sutures—include the. Fig. 58.—This Figure Shows the Manner of Closing the Wound by the Tier or Layer Method ofSuturing. The peritoneum and fascia are held by a chain stitch, the muscle and its sheath by awhipover stitch. A subcuticular stitch is employed for the final closure of the wound. edges of the peritoneum alone, or of the peritoneum and transversalis fasciacombined. The second set of sutures, of the continuous or the intermpted type,and consisting of heavy chromicized gut, include the sheath of the rectus abdom-inis, the transversalis fascia, the subperitoneal areolar tissue, and the margin ofthe rectus (if cut). The chief support is furnished by this second set of third set, the chief purpose of which is to obliterate dead spaces, consists ofcatgut sutures which are passed through the subcutaneous areolar tissue either ABDOMINAL SECTION. 131 intciTii])t((lly or as a single eoiitinuous conl. The la
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
