. A new manual of surgery, civil and military. Eepresents the hernial ring in an umbilical hernia laid bare, -with the tissues dissected backdown to the aponeurosis. Two fingers of one hand are inserted into the abdominal cavityin order to protect the intra-abdominal organs against injury from the needle, which is insertedone and one-half to two inches from the edge of the ring. A blunt hook is inserted on eitherside to stretch the ring transversely. (5) For this approximation an incision is made through the aponeuroticand peritoneal structures of the ring extending one inch or more transverse
. A new manual of surgery, civil and military. Eepresents the hernial ring in an umbilical hernia laid bare, -with the tissues dissected backdown to the aponeurosis. Two fingers of one hand are inserted into the abdominal cavityin order to protect the intra-abdominal organs against injury from the needle, which is insertedone and one-half to two inches from the edge of the ring. A blunt hook is inserted on eitherside to stretch the ring transversely. (5) For this approximation an incision is made through the aponeuroticand peritoneal structures of the ring extending one inch or more transverselyto each side, and the peritoneum is separated from the under surface of theupper of the two flaps thus formed. 350 GENERAL SURGERY OF THE ABDOMEN (6) Beginning from one to one and one-half inches above the marginof the upper flap, three to four chromicized catgut mattress sutures are intro-duced, the loop firmly grasping the upper margin of the lower flap; sufficienttraction is made on these sutures to enable peritoneal approximation Avith. Umbilical Hernia. Represents three chromicized cat-gut stitches in position. The cat-gut is representeddouble. This is not important, but has the advantage of extra security in case there shouldbe a defect in one strand, besides making it possible to use a smaller size of cat-gut. running sutures of catgut. The mattress sutures are then drawn into position,sliding the entire lower flap into the pocket previously formed between theaponeurosis and the peritoneum above. (7) The free margin of the upper flap is fixed by catgut sutures to thesurface of the aponeurosis below, and the superficial incision closed in the GENERAL SURGERY OF THE ABDOMEN 351 usual manner. The lateral approximation is carried out by sliding one sideunder the other in the same manner. In the larger hernias the incisionthrough the fibrous covering of the sac may be made somewhat above thebase, thereby increasing the amount of tissue to be used in the overlappingprocess.
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
