LIGATION 



85 



In the course of surgical operations it is, however, advis- 

 able, when possible, to ligate vessels before they have been 

 cut. Whenever it is known that a certain large artery or vein 

 must be sacrificed in the execution of the steps of an opera- 

 tion its isolation and its ligation, proximally and distally, 

 should be effected at all hazards before destroying its contin- 

 uity. Superficial vessels, especially subcutaneous veins, 

 which cross the line of incision, should be dissected out and 

 ligated at each edge of the cutaneous incision before being 

 cut, in order- to intercept the vexing haemorrhage. Veins 

 which stand out prominently wiil collapse and retract into the 

 tissues after their continuity is severed, and will be much 

 more difficult to manage than before they were divided. 



Fig. 43. 

 Figs. 42 and 43— Ligating Forceps for Vessels. 



When a ligated vessel is in close proximity to. the cuta- 

 neous incision the thread should be cut long so that its ends 

 may protrude to the surface between the edges of the incision, 

 thus facilitating removal by traction as soon as the stump 

 has sloughed through. Buried ligatures which can not again 

 be reached on account of healing of the surface wound should 

 be cut short so as to leave only a small amount of irritant sub- 

 stance in the trauma. Absorbable ligatures,— fine silk or 

 catgut, — only are admissible for this latter purpose. 



The Ligation of Growths.— A small pedunculated growth, 

 or any. one with a narrow base, is strangulated by simply pass- 

 ing a cord around it as close to the surface of the body as pos- 

 sible and then drawing it taught enough to effect a total 

 strangulation of the circulation. The cord should be of good 



