174 THE BAYER SUTURE 



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. deep, 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 are applied in 

 the same way. 



The lips of the wound are then united by continuous ap- 

 proximation 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 beneath the latter 

 sutures and fixed by a separate suture. 



The entire cutaneous surface lying between the drainage 

 tubes is covered with antiseptic 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 lower- 

 most splints should be secured to the tubing by means of 

 sutures passed through them. The entire bandage is finally 

 saturated with antiseptics. The bandage and retention 

 sutures should remain eight days, the approximation sutures, 

 fourteen. 



