TREATMENT OF WOUNDS 107 



that cross the wound line at a right angle. They are 

 made to extend from about three inches on one side to 

 about the same distance on the other. A full curved 

 needle is armed with about two feet of single thread. Be- 

 ginning say three inches from the wound line, the 

 needle is passed subcutaneously or even deeper toward 

 the wound, coming out three quarters of an inch from 

 the point of entrance. One foot of the thread is drawn 

 through. The dangling end is then tied with a double 

 knot at the exit point, the knot lying upon the hole. 

 Letting the end dangle again, the needle is now in- 

 serted through the exit point and brought out again 

 three quarters of an inch toward the wound, where 

 the dangling end is again tied in the same way. These 

 are continued across the wound to about the same dis- 

 tance on the opposite side. The loops are not tied tight 

 enough to block circulation but just tight enough to 

 lie straight. When one is completed another is put in, 

 one, two, or three inches away, and so on, until the whole 

 field of skin is firmly recarpeted to the body. 



It is almost a physical impossibility for a skin flap so 

 fixed to break away from the body. Even when active 

 inflammation follows, the flap stays fixed. 



The drainage orifice, provided by leaving a dependent 

 part unsewed or by making a counter-opening, is now 

 wadded with an aseptic gauze wick. The first wadding 

 should be tight so as to dilate the orifice. Subsequent 

 waddings must be more loosely arranged to allow outflow 

 of discharges. 



We now "touch up" the sutures along the wound 

 with tincture of iodin and then varnish the whole field 

 with^four or five successive layers of collodion. These 

 thick applications of collodion play an important role in 

 supporting the sutures, and they also afford a perfect 

 cloak to keep out external soiling. 



