208 



OPEKATIONS ON THE SKIN AND CELLULAR TISSUE. 



Fig. 239.— The Liga- 

 tures Secured. 



Fig. 238.— The Tumor divided 

 In Four. 



Fourth Method, Subcutaneous Ligature. — This method is sel- 

 dom practiced, as there are always objections to leaving under 

 the skin the mortified structures divided by the constriction of the 

 cord. But as there may be circumstances under which the growth 

 cannot be immediately uncovered, its application becomes a ques- 

 tion of necessity. 



Three needles are required: one, A, straight and sharp; the 

 second, B, straight and pointed; the third, C, curved and also 

 pointed. These are placed upon a single long thread. 



Fig. 240.— Thread and Needles for Subcutaneous Ligatiires. FiG. 241.— 1st Step. 



The growth A being subcutaneous, and spherical in shape, a 

 vertical cutaneous fold is raised above its superior thii'd, through 

 the base of which the needle A is introduced. Leaving the fold 

 loose, and the skin resuming its position, a first portion of Uga- 

 ture is found in place, under the teguments, surrounding one- 

 third of the cii-cumference at C (Fig. 2il). The curved needle, C, 

 is then passed through the tumor, entering at C, and coming out 

 at B, with the loop D, and at B the needle is removed (Fig. 242). 



By these first steps of the operation, the superior thii'd of the 

 growth is surrounded by the loop of thread B, C, D, both of whose 



