The closure of laparotomy wounds as practised in Germany and Austria : including detailed methods and views communicated by over fifty leading surgeons / ed. and tr. by Walter H. Swaffield.
- Date:
- 1904
Licence: Public Domain Mark
Credit: The closure of laparotomy wounds as practised in Germany and Austria : including detailed methods and views communicated by over fifty leading surgeons / ed. and tr. by Walter H. Swaffield. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![bute to its strength, each, to eacli as tliey origi- nally lay before operating. The consequences of a bad abdominal wound suture are (1) omental or intestinal adhesions to the wound, with ensuing disturbances of the stomach or of general peristalsis; (2) hernise, with later risks of incarceration; (3) fistulse and chronic inflammation of the abdominal wound region. 1. As against adhesions, the mere careful sutur- ing of peritoneum with thin sterile catgut is not a full protection : it is needful besides to avoid during the whole operation all superfluous and injurious irritation of the peritoneum. Danger- ous adhesions I have chiefly seen after laparoto- mies for pyosalpinx; for this reason alone, apart from all others, it is worth the trouble to operate through the posterior vaginal incision, a route which, according to my experience, is feasible in all cases. 2, Hernige in the scar arise (a) through inexact uniting of the peritoneum, inasmuch as the latter or the omentum, etc., insinuates itself into the line of suture, and acts like a wedge in pushing the tissues asunder; (]j) more frequently along with the through-and-through suture, owing to constricting action by the stitches within their canals; (c) lastlj^, through sagging apart of a scar incapable of resistance, the corresponding layers not having healed together, whereas por- tions of muscle or fat get j^i'essed into the wound in the anterior fascia, disappear at that point](https://iiif.wellcomecollection.org/image/b21167448_0015.jp2/full/800%2C/0/default.jpg)
