272 SURGICAL APPLIED ANATOMY., [Chap. xvi. 



stretching of the peritoneum which occurs under 

 certain circumstances. 



Wounds of the abdomen may give trouble in 

 their treatment, since, when inflicted, they may open 

 up several layers of fascia and so lead to bagging of 

 pus and to the spread of suppuration should an abscess 

 follow the lesion. When the more muscular parts 

 are divided the condition of the layers incised is 

 such that great facilities are offered for the em- 

 bedding of small foreign bodies, such as pieces of 

 glass, etc., which, hidden between the muscular layers, 

 may well be overlooked. Mr. Pollock records a case 

 where the metal part of a steel fork with two prongs 

 was overlooked and allowed to remain buried in 

 the abdominal walls for a considerable time. 



The frequent movement of the belly walls does 

 not favour that rest which is so essential to the healing 

 of wounds. 



In penetrating wounds the contraction of the 

 muscles may encourage the protrusion of the viscera, 

 especially when the incision is transverse to the 

 direction of the muscular fibres. In reducing small 

 portions of protruded viscera it is quite possible to 

 push them into one of the connective tissue spaces 

 between the muscles or into the subserous tissue 

 instead of into the peritoneal cavity. In applying 

 sutures to wounds involving the whole thickness of 

 the parietes it is necessary that the threads should 

 include the peritoneum so that earty healing of that 

 membrane may be brought about. Without such 

 precaution a gap may be left in the surface of the 

 peritoneum which would favour the formation of a 

 hernia in the site of the old wound. 



Blood-vessels. The only arteries of any magni- 

 tude in the abdominal walls are the two epigastric 

 arteries, some branches of the deep circumflex iliac, 

 the last two intercostal vessels, the epigastric branch 



