SETONING 



95 



ing the tracts and penetrating the tissues, but when these are 

 used an incision must be made with the scalpel at the point 

 of exit, determined by palpating the blunt point of the needle 

 within. 



TECHNIQUE.— First Step.— Preparing the Field.— 



The hair must always be closely clipped over a liberal sur- 

 face in the interest of general cleanliness of the operation, 

 as well as to rid the region of long hairs which are certain 

 to be drawn into the seton tract during the after-treatment 

 as well as at the time of insertion. In addition to the clip- 

 ping the whole area is washed with soap and water and then 

 rinsed clean with mercuric chloride 1-500. At the points of 

 entrance and the points of exit the hair is shaved closely 

 with the razor. 



Second Step.— Incising the Skin at the Points of En- 

 trance.— The skin in each of the shaved spots representing 



Fig. 46 — Seton Needles. 



the entrance points, is picked up with the thumb and finger 

 of the left hand and incised about one-half, inch with one 

 plunge of the scalpel. 



Third Step. — Inserting the Setons. — The needle, previ- 

 ously armed with tape of necessary length, is passed into the 

 incision and then forced downward through.the subcutaneous 

 areolar tissue with 3 firm but gentle pressure. The curved 

 end of the needle, being pointed outward, must be guarded 

 against a premature puncture through the skin by pulling 

 the uppermost end from the body as it passes downward and 

 until the sharp point is felt beneath the skin at the shaved 

 point of exit;* then, with a sudden thrust, the needle is forced 

 through and the tape is drawn into the tract. 



Fourth Step. — Tying the Tape. — There is the choice of 

 two methods of preventing setons from being pulled out; 

 ane being that of tying the two ends together into a loose 

 loop, and the other is that of tying a light, rounded stick of 



