. Surgery, its principles and practice . th one of the best of operators. The cecum is then returnedinto the abdomen. If the appendix has not Iuptured and the mesenteryis not infiltrated, drainage is unnecessary, regardless of the quantity ofseropurulent (staphylococcus albus) fluid present. When the mesenteric TYPHLITIS, PERITYPHLITIS, EPITYPHLITIS. 785 stump is infiltrated and the peritoneum blistered, a small tubular draiais always advisable. The peritoneum is closed with catgut suture (No. 2) and the cut edgeeverted. In inserting the suture one should always bear in mind theproximity of th
. Surgery, its principles and practice . th one of the best of operators. The cecum is then returnedinto the abdomen. If the appendix has not Iuptured and the mesenteryis not infiltrated, drainage is unnecessary, regardless of the quantity ofseropurulent (staphylococcus albus) fluid present. When the mesenteric TYPHLITIS, PERITYPHLITIS, EPITYPHLITIS. 785 stump is infiltrated and the peritoneum blistered, a small tubular draiais always advisable. The peritoneum is closed with catgut suture (No. 2) and the cut edgeeverted. In inserting the suture one should always bear in mind theproximity of the deep epigastric artery and vein. A suture passed througheither of these might lead to serious and continuous hemorrhage, as oc-curred in one of our cases. The aponeurosis is now united edge to edge with a No. 3 catgut brierstitch. An additional support may be given to this by figure-of-eightsilkworm-gut stitches placed | of an inch apart, the lower loop includingthe divided edge of the aponeurosis, and the upper all of the superstruc-. FiG. 430.—Showing the Final Lembert Suture of the Cecal Wall and Appendical Stump. tures and skin. Before these stitches are tied the edges of the skin maybe approximated either with a subdermal catgut or a horsehair or silkcontinuous suture. We prefer the horsehair. A roll of gauze | of an^inch in diameter is now placed over the edgeof the wound and the silkworm-gut tied taut over this. This makes acomplete apposition of all of the cut surfaces with no dead spaces forwound secretion. Six layers of gauze and one of absorbent cotton are placed over thewound, held in position by adhesive strips and a binder. The adhesivestrips prevent displacement of the dressings beneath the binder. In casesnot drained the dressing is not disturbed for ten days. The patients arepermitted by some operators to get up on the third to the fifth day, but VOL. IV—50 786 SURGERY OF THE APPENDIX VERMIFORMIS. we consider it questionable practice, preferring ten to tw
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