98 



OPERATIVE TECHNIQUE. 



When larger tracts of tissue are in question the fingers of both 

 hands may be employed Although wounds so made are really torn 

 wounds, and bleed relatively little, they often heal very rapidly. 



Ligatures. — Soft tissues may be divided by passing around them 

 a thin tightly-stretched cord. Linear necrosis continues at the point 

 of ligation until the cord becomes slack, but inasmuch as many 

 materials like reindeer sinew or metallic ligatures are comparatively 

 inelastic, the ligature may after a time require to be reapplied, and 

 large masses cannot be dealt with by a single ligature, but require 

 several. In such cases the elastic ligature is exceeding useful. 

 Being applied in a tensely stretched condition it '" follows up " the 

 parts as they yield. As stated, the ligature is applied in a stretched 

 condition. After being firmly tied with a string or silk thread the ends 

 are released, and as they immediately return to their previous volume 

 they so greatly exceed the area of the knot as to render impossible 



Fig. log. — Diagram showing elastic 

 ligature applied. 



(. I lo. — Dia- 

 onun to show ex- 

 tent to which 

 contraction pro- 

 ceeds. 



any chance of retraction. Fig. 109 shows a ligature applied to a rod. 

 and Fig. no, the same ligature removed, to exhibit the degree to which 

 it finally contracts. Solid rubber cords are better than drainage-tubes, 

 which are apt to break when tied. An erroneous belief pre\ails that 

 the thicker the part to be divided the thicker must be the rubber cord, 

 but in reality a thin cord has a relatively greater power of contraction, 

 and is therefore more useful. The surfaces left by the elastic ligature 

 granulate readily. This method is especially useful in ligaturing 

 very vascular tissues because vessels are securel}' closed before 

 division occurs. 



The Eckaseur. — The ecraseur effects the same result in a similar 

 but more rapid fashion. It consists of an articulated steel chain, 

 the loop of which is passed around the part to be divided and 

 drawn tight until the tissue is iinall}- crushed through. Chas- 

 saignac's ecraseur (higs. iii and 112) acts by means ot the two rods 



