THE BAYER SUTURE. 181 



threads of the suture separating from each other. The 

 needle is then passed through the opposite lip of the wound 

 from within to without at the same distance from the lips, 

 the needle removed, the free ends drawn taut and a single 

 knot tied against the skin to prevent the separation of the 

 two threads for the reasons just stated above, the second 

 large drainage tube, d" , is laid between the open ends of 

 the double silk thread and these are tied upon it with a 

 triple knot, after they have been drawn sufficiently tight 

 that the approximated wound lips form a crest. If the lips 

 of the wound can be grasped with the hand and held to- 

 gether in such a manner as to form a ridge 3 or 4 cm. high, 

 the suture needle can be passed through both simultaneously. 

 The first suture should be located about 3 cm. beneath the 

 upper angle of the wound, the other retention sutures follow 

 at distances of about 5 cm. from each other and applied in 

 the same way. The lips of the wound are united by contin- 

 uous approximation sutures like an overcasted seam. This 

 suture ends at least 2 cm. above the lower angle of the 

 wound. The third drainage tube is introduced into the 

 latter and fixed by a special suture. The entire cutaneous 

 surface lying between the drainage tubes is covered with 

 iodoform gauze, and between each two retention sutures 

 there is laid over this gauze the wooden splints previously 

 cut to the proper size, the ends of which are shoved under 

 the tubing. The upper- and lowermost splints should be se- 

 cured to the drainage tubing by means of sutures passed 

 through them. The entire bandage is finally saturated with 

 iodoform ether. The bandage and retention sutures remain 

 eight days, the approximation sutures fourteen. 



