Umbilic Hernia 



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the hernial ring, including all of the hernial sac, thus excluding 

 the possibility of the intestine slipping out from behind or in 

 front of the sutures. By this method the hernial sac does not 

 become necrotic, and is not destroyed if the operation has been 

 carried out under strict antiseptic precautions. Under this plan, 



Fig. 151. Diagrammatic Illustration of Sutures for 

 Umbilic Hernia. 



A, Cross section through the hernial ring and sac, showing relations of su- 



ture to hernial parts, i. Peritoneum ; 2, Muscles of abdominal floor ; 3, 

 Skin and subcutaneous tissues ; 4, Suture ; 5, Hernial opening. 



B, Diagram of hernial ring viewed from below, with hernial sac cut away 



to show plan of sutures, i. Hernial ring ; 2, Margin of the skin where 

 hernial sac has been cutaway ; 3, 3, Areas between the sutures in which 

 the hernial sac is not strangulated ; 4, 4, 4, Areas in hernial sac which 

 are included in the sutures but which still receive a vascular supply 

 from areas 3, 3. 



according to our experience, the hernial ring closes more surely 

 than with strangulation and necrosis of the hernial sac, and any 

 risk from rapid or extensive sloughing is excluded. A broad, 

 many-tailed bandage is applied around the body, and an antiseptic 

 pack is applied over the operative area and repeatedly saturated 

 with antiseptics until danger from infection has passed. The 

 bandage is kept in place for five or six days, and the sutures are 

 left in position for three weeks or longer, when they are to be 



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