. St. Thomas's Hospital reports. utures are closed, ifthis has not already been done, or by taking the tension off thestitches by making a vertical incision, as Dieffeubach did, abouta quarter of an inch in length on each side of the fissure. Whennecessary the anterior and posterior pillars of the fauces, withsome fibres of the palato-glossus and palato-pharyngeus, may bedivided. The accompanying woodcut (figs. 17, 18j show theincisions referred to. Respecting the operation a few practical points may not beout of place. There is often some difficulty in grasping thethread when passed through b
. St. Thomas's Hospital reports. utures are closed, ifthis has not already been done, or by taking the tension off thestitches by making a vertical incision, as Dieffeubach did, abouta quarter of an inch in length on each side of the fissure. Whennecessary the anterior and posterior pillars of the fauces, withsome fibres of the palato-glossus and palato-pharyngeus, may bedivided. The accompanying woodcut (figs. 17, 18j show theincisions referred to. Respecting the operation a few practical points may not beout of place. There is often some difficulty in grasping thethread when passed through by the needle, but it may be easilysecured if the needle be thrust freely and somewhat roughlythrough and slightly withdrawn at once ; but this must bedone immediately and before the thread gets saturated withmoisture. A slight loop in the ligature is thus formed, which On CU-ft Valati. 71 can be readily secured in tlic grasp of tlic forceps. Variousinstruments have been devised to catch the thread, but they are Pig. 17. Fio. /<W^ unnecessary, as a pair of forceps such as those already referredto answer the purpose perfectly. It is important, too, not todraw the stitches together too tightly, for there is generally alittle swelling after the operation, and allowance must be madefor this, but in referring to this point it must be distinctly un-derstood that the edges must be applied with the most perfectprecision, otherwise union cannot be expected. It is desirable,also, to place the knots so that they shall not lie exactly overthe wound. In order to increase the breadth of the raw surfaceI have seen Sir William Fergusson take a curved knife and runit along the cut surface. This he thinks gives a greater pro-bability of union.^ As to the length of time the stitches should remain is apoint on which there is much difference of opinion. Sir advises their removal about the third or fourth day;but then he was guided by circumstances, and has left them evento the el
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