. The practice of anæsthetics . 5- in. distal to ligature ; notethat no bleeding occurs from stump and return toabdomen. Sac is now carefully isolated from cordor round ligament, the usual place to begin this beingnear the internal ring. Isolate neck of sac thoroughly,draw down and if narrow ligature with catgut; ifbroad, pass double catgut suture transversely throughmiddle and tie each side separately, interlocking liga-tures. Cut sac off |- in. distal to ligature and allowstump to slip back into abdomen. Pick up forceps onlower side of external oblique aponeurosis, make thistaut, and expose
. The practice of anæsthetics . 5- in. distal to ligature ; notethat no bleeding occurs from stump and return toabdomen. Sac is now carefully isolated from cordor round ligament, the usual place to begin this beingnear the internal ring. Isolate neck of sac thoroughly,draw down and if narrow ligature with catgut; ifbroad, pass double catgut suture transversely throughmiddle and tie each side separately, interlocking liga-tures. Cut sac off |- in. distal to ligature and allowstump to slip back into abdomen. Pick up forceps onlower side of external oblique aponeurosis, make thistaut, and expose Pouparts ligament by dissection withpoint of closed scissors (fig. 54). Define conjoined ten-don. Insert two or three (according to size of opening) 324 EMERGENCY OPERATIONS sutures of stout catgut or silk, taking good hold ofconjoined tendon and upper surface of Pouparts liga-ment, and tie sufficiently firmly to make these twostructures lie together snugly. The upper of thesesutures obliterates the internal ring ; the lower is. Fig. 54.—Exposure of Pouparts ligament and conjoined tendon. Theligatured neck of the sac is shown, but it should have retracted out ofsight into the abdomen. placed so as to leave room for the cord to emergeinternal to it. Upper and lower edges of e.\ternaloblique aponeurosis are now made to overlap, thelower one undermost, and are in position bymattress sutures of catgut. In passing sutures nearPouparts ligament care must be taken to avoid injury EMERGENCY OPERATIONS 325 to femoral vessels. Suture subcutaneous tissues withfine catgut and insert subcuticular suture to closeexternal wound. Dressings.—Dressings are applied with firm compres-sion over wound and removed in twenty-four hourswhen tendency to effusion will have subsided. Woundthen covered with mild antiseptic powder, , boricacid. Patient kept in bed for three weeks, and forfollowing three weeks must do no hard work. (Seealso p. 310.) If condition of houel be verv doubtful, but
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