THE BA YER SUTURE. 21 1 



threads of the suture separating from each other. The 

 needle is then passed through the opposite lip of the wound 

 from within to without at the same distance from the lips, 

 the needle removed, the free ends drawn taut and a single 

 knot tied against the skin to prevent the separation of the 

 two threads for the reasons just stated above. The second 

 large tube, d" , is laid between the open ends of the double 

 silk thread and these are tied upon it with a triple knot, 

 after they have been drawn sufficiently tight that the 

 approximated wound lips form a crest. If the lips of the 

 wound can be grasped with the hand and held together in 

 such a manner as to form a ridge 3 or 4 cm. long, the 

 suture needle may be passed through both simultaneously. 

 The first suture should be located about 3 cm. beneath the 

 upper angle of the wound, the other retention sutures follow 

 at distances of about 5 cm. from each other and applied in 

 the same way. 



The lips of the wound are then united by continuous 

 approximation sutures like an overcasted seam. This 

 suture ends at least 2 cm. above the lower angle of the 

 wound. The third tube, for drainage, is introduced be- 

 neath the latter sutures and fixed by a special suture. 



The entire cutaneous surface lying between the drainage 

 tubes is covered with iodoform gauze, and between each two 

 retention sutures there is laid over this gauze the wooden 

 splints previously cut to the proper size, the ends of which 

 are pushed under the tubing. The upper- and lowermost 

 splints should be secured to the drainage tubing by means 

 of sutures passed through them. The entire bandage is 

 finally saturated with iodoform ether. The bandage and 

 retention sutures remain eight days, the approximation 

 sutures fourteen. 



