. Manual of operative surgery. k mm. to one side of the former suture andtied. (This suture is really a single mattress suture.) The suture is continuedas a continuous mattress suture, dropping back half a stitch every third sutureuntil the starting-point is reached; then a half stitch is made and the suture con-tinued back as a whip-stitch until the starting-point is reached again; then thetwo ends are tied (Figs. 974 and 975). The suture is started on the anteriorsurface near the handles of the clamps. When the suture reaches the fartherside of the artery the handles of the clamps are ta
. Manual of operative surgery. k mm. to one side of the former suture andtied. (This suture is really a single mattress suture.) The suture is continuedas a continuous mattress suture, dropping back half a stitch every third sutureuntil the starting-point is reached; then a half stitch is made and the suture con-tinued back as a whip-stitch until the starting-point is reached again; then thetwo ends are tied (Figs. 974 and 975). The suture is started on the anteriorsurface near the handles of the clamps. When the suture reaches the fartherside of the artery the handles of the clamps are taken from the lower portionof the wound and placed in the upper portion. In this way the surface ofthe artery which was anterior is now posterior, and the suture can always bekept in sight. Carrels —Step i.—Introduce three tension sutures of very finesilk impregnated with vaseline at equidistant points of the circumference of thevessel ends (Fig. 976).* These sutures penetrate the whole thickness of Fig. 977.—{Carrel.) Step 2.—Have an assistant apply traction to two of these sutures so as tostretch the portion between the two sutures into a straight line and to approxi-mate the corresponding cut edges of the vessel. Apply a hemostat to the thirdtension suture and let it hang so as to pull on the suture. The slight pulling onthe three sutures arranges the circumference of the vessel as a triangle, and thisfacilitates suturing. Step 3.—Introduce a continuous overhand stitch through all the coats allround the vessel. The stitches should be very close together and only drawntightly enough to secure approximation, but not tightly enough to produceeversion of the edges of the wound (Fig. 977). Step 4.—Remove the distal clamp (used for provisional hemostasis). Re-move the proximal clamp. If there is any bleeding, gentle finger pressure will * In the illustration four tension sutures have been employed. VENOUS IMPLANTATION 819 almost always stop it
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