Operative surgery . loyedin a similar way, using two or more strands for thepurpose, according to the size of the vessel, the degreeof force of the circulation, and the structural in-tegrity of the coats. However, the floss-silk knotis softer than that formed by the preceding firmeragents, and therefore less liable to cause unequal pressure of the constrictedvessel and the greater danger of hemorrhage that attends their use. The atrophy of the inner coats of vessels caused by the compression ofthe ligatures, when not attended with division of these structures, is variable,being modified in its
Operative surgery . loyedin a similar way, using two or more strands for thepurpose, according to the size of the vessel, the degreeof force of the circulation, and the structural in-tegrity of the coats. However, the floss-silk knotis softer than that formed by the preceding firmeragents, and therefore less liable to cause unequal pressure of the constrictedvessel and the greater danger of hemorrhage that attends their use. The atrophy of the inner coats of vessels caused by the compression ofthe ligatures, when not attended with division of these structures, is variable,being modified in its extent by the degree and the area of the compressingforce, also by the actual state of the circulation in the tissues themselves. It will be noted (page 162 et seq.) that in ligature of the innominatethis variety of knot is especially indicated, and, moreover, it is not at alluncertain that in the successful outcomes of ligatures of this importantvessel the stay-knot of Ballance and Edmunds has contributed no unim-. FiG. 120.—The floss-silkstay-knot. «. The com-bined fold, completedknot. b. The inde-pendent single folds. AGENTS FOR THE CONTROL OF HAEMORRHAGE. 85 DOUBLE TURN. FRICTION KNOT - SINGLE TURN, SINGLE TURN. REEF KNOt portant factor to the manner of the application, also no insifjnificantamount of the favorable features of spinal cases can be justly attributed. The difficulty of the removal of deep-seated ligatures, especially whenconnected with pedicles, is not a new or trifling matter. Dr. Grad has de-vised the following ingenious and excellent plan for the loosening and re-moval of this class of ligatures (Fig. 121). As will be noted in the illustra-tion, an independent traction loop is included beneath each fold of the ligature in the tyingof the knot, and theorder of the relationto the surface of therespective loops isindicated numericallyby knots tied in end of the liga-ture is cut short topermit more readily the displace-ment by the traction loops. I
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