. Plexus. point at thetime of removal, As the bow-knot is intended only to form a body toobstruct the passage of the sutures through the fascia, itshould be tied loosely, to make a larger obstruction, and tofacilitate its untying at the time of removal. The ends of the tied suture must not be held out of theway by snap-forceps, as their weight might untie the knots. The linea alba, being securely fastened, takes all ofthe tension from the other layers, and the unfastened su-tures in the other layers do not tend to pull loose. The skin is closed by the Halstead subcutaneous stitch.(Fig. 3,) If
. Plexus. point at thetime of removal, As the bow-knot is intended only to form a body toobstruct the passage of the sutures through the fascia, itshould be tied loosely, to make a larger obstruction, and tofacilitate its untying at the time of removal. The ends of the tied suture must not be held out of theway by snap-forceps, as their weight might untie the knots. The linea alba, being securely fastened, takes all ofthe tension from the other layers, and the unfastened su-tures in the other layers do not tend to pull loose. The skin is closed by the Halstead subcutaneous stitch.(Fig. 3,) If the patient is very fat, an extra running suture canbe placed to approximate the fat and to avoid a dead space. If the wound is too long to close with a single silkwormgut strand, it is closed in sections, by repeating each suture. Lateral celiotomies are closed by suturing each layerof fascia with a tied strand of silkworm gut, not allowingmuscle or fat to be included in the suture. Closure of Wounds. 95. Fig. 3. 3ut»r« of Superficial Layer. 96 The Plexus. INGUINAL HERNIA. The omentum and hernial sac are treated as usual. Around, straight needle is placed in position at or below theneck of the sac, for a continuous mattress suture. (Pig. 5.) The sac is cut away,the silkworm gut sut-ure is drawn throughand shirred up tightly,the ends fastened to-gether and left pro-truding from the upperangle of the wound;the stump of the sacdropped back behindthe internal ring. Ifthe sac is large, andthick, and old, and lia-ble to bleed, it is cutoff at the neck, hem-orrhage stopped bypressure and torsion,and the edges broughttogether with a her-ring-bone silk - wormgut suture, similar tothe peritoneum in amedian laparotomy,(Fig. 1.) The conjoined ten-don is drawn behindthe cord, and its flatsurface is attached to the thick underpartof %Pouparts liga-ment by a continuous tied basting-stitch. The suture with the first bow knot already tied is passedthrough the deep, thick, firm, wtiite part o
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