. A manual of operative surgery . , or who cannotreach the transversalis fascia in the loin, without the use^of adirector, had better abandon operating. The liberal employ-ment of a director is a demonstration of inefficiency, and thelong list of special directors is not creditable to surgical progress. In exposing a deep part, such as the sac of the hernia, thewhole process should be effected by clean incisions. The knife CHAP. V] MAKING OF THE WOUND 67 should follow the same precise line, and be carried neatly fromone end of the wound to the other. The layer of tissue next to be divided shou
. A manual of operative surgery . , or who cannotreach the transversalis fascia in the loin, without the use^of adirector, had better abandon operating. The liberal employ-ment of a director is a demonstration of inefficiency, and thelong list of special directors is not creditable to surgical progress. In exposing a deep part, such as the sac of the hernia, thewhole process should be effected by clean incisions. The knife CHAP. V] MAKING OF THE WOUND 67 should follow the same precise line, and be carried neatly fromone end of the wound to the other. The layer of tissue next to be divided should be carefullypicked up with the forceps, and the piece so held may be gentlymoved from side to side, in order that its density, its thickness,and its freedom from deeper connections may be made and then, in approaching a hernical sac, the tissues maybe pinched between the finger and the thumb, so that thethickness of the remaining layers may be estimated, and theposition of the contained bowel or omentum defined. k mi m. FIG. 27. —MODE OF EXPOSING A TUMOUR BY LIGATURE OR THREAD RETRACTORS. It is desirable also that the margin of the wound shouldnot be bruised or damaged by uncouth retractors. The simplewound-hooks and the wound-retractors described already(page 48) effect the least disturbance of the divided tissuesand make the least encroachment upon the field of the of all kinds, however, must be used with a lighthand. In performing many small operations we make use of whatmay be termed ligature retractors. After the incision throughthe skin and the subcutaneous tissues and fasciae has been 68 GENERAL PRINCIPLES [part i made, the margins of the wound are held aside by means ofsilk ligatures, which are inserted close to the cut edge on eachside (Fig. 27). These ligatures occupy no room, interfere in no way withthe surgeons movements, and do not encroach upon the fieldof operation. They should be of considerable length, so thatthe assistant who
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