. American practice of surgery ; a complete system of the science and art of surgery . a posterior imbrication is the kind of opera-tion preferred. (a) In anterior imbrication place from two to five strong stitches in such AlUt iMINAl. lIl-:i{MA. 581 a manner as to unite the conjoined tendon and muscles, together with the uppersegment of the external oblique, finiily down to Poui^aits ligament, all in frontof the cord, which is thus pushed backward and toward the jxibis. The lowerflap of the external oblique is left free for step 5. [b) In posterior imbrication lift up the cord on a loop of ta
. American practice of surgery ; a complete system of the science and art of surgery . a posterior imbrication is the kind of opera-tion preferred. (a) In anterior imbrication place from two to five strong stitches in such AlUt iMINAl. lIl-:i{MA. 581 a manner as to unite the conjoined tendon and muscles, together with the uppersegment of the external oblique, finiily down to Poui^aits ligament, all in frontof the cord, which is thus pushed backward and toward the jxibis. The lowerflap of the external oblique is left free for step 5. [b) In posterior imbrication lift up the cord on a loop of tape, or on Andrewshernia-retractor (Fig. 222) wliieh liolds the wound open and has an adjustablehook upon which the cord may be suspended. Pass the deep stitch behind thecord by first lifting Poupaits ligament on the left forefinger and pushing theneedle from outside the fascia behind it. The needle point is guided by theforefinger and cannot then injure the vessels. It is Aitally important, in directhernias and in the case of large rings, to get the fii-st deep .stitch as near the. Fig. 220.—Dimple or Fuimel of Peritoneum Seen from Inside when the Sac is not Extirpated entirelyfrom the ring. Tliis error in technique, in the Andrews Operation, causes a tendency to relapse afterherniotomy. (Original.) pubic end of the ligament as possible. It often includes a little of Gimbernatsligament. Dr. Malcolm Harris first called my attention to the importance ofthis, and one cannot commend too much the thorough way in which he cleai-sthe structures and fortifies this weak end of the suture line by placing (accordingto his method) the first wire suture almost against the s^Tuphysis. From itsentrance point the needle is guided by the forefinger into the canal. It is thenpicked up and the opposing muscle entered from within outward. The lowestor first stitch in large rings should include a little of the rectus muscle, tnesheath being spHt open to allow this. In smaU lings this is not neces
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
