Operative surgery . Fig. 236.—The fusiform aneurism. The first rowof sutures iirmly closing the orifices by finechromicized catgut or silk. skin with sutures carried so asto secure the line of union to theimmediate underlying structures;tie firmly in place over gauze padsthe transfixion sutures, thus com-pletely obliterating the sac (). In the Sacciform Aneurism(Fig. 240) the single opening isclosed by sewing (Fig. 241),as in the preceding illustration(Fig. 242), but without encroach-ing materially on the diameter ofthe lumen of the main artery. The Operation.—Expose, openand treat the
Operative surgery . Fig. 236.—The fusiform aneurism. The first rowof sutures iirmly closing the orifices by finechromicized catgut or silk. skin with sutures carried so asto secure the line of union to theimmediate underlying structures;tie firmly in place over gauze padsthe transfixion sutures, thus com-pletely obliterating the sac (). In the Sacciform Aneurism(Fig. 240) the single opening isclosed by sewing (Fig. 241),as in the preceding illustration(Fig. 242), but without encroach-ing materially on the diameter ofthe lumen of the main artery. The Operation.—Expose, openand treat the aneurismal sac asin the operation for cure of fusi-. FiG. 237.—The fusiform aneurism. Thesecond row of sutures. These may bethe interrupted or continued. If floorbe rigid the second row may be omitted. THE LIGATURE OP ARTERIES. 209 form aneurism (Fig. 243) ; close by interrupted or continuous sutures,passed as indicated in illustrations, andwithout or with the introduction of thecatheter (Figs. 243, 244), the open-ings of the main artery (Fig. 245);practice the remaining steps of theoperation as in the preceding one, caus-ing the outline of the transverse sectionto conform with that of Fig. 246). The Remarks.—This method ofpractice does not interfere with thestructures contiguousto the sac, as in extir-pation. The wound isof minimum size andcumscribed boundaries,fluous sac-wall should be the sac is nourished byperivascular structures, as littleseparation of it as possibleshould take place. Vari-ous agents for control ofha?morrhage can be util-ized when the Esmarchbandage is not suitable forpurpose. Kangaroo tendon with
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