PENETRANT ABDOMINAL WOUNDS 491 



placed along the tract so as to invade the abdominal cavity 

 about one inch, and protrude from the external orifice about 

 two inches. Over this the muscular layers are sutured with 

 strong catgut interrupted sutures placed' no less than one- 

 half inch apart. The cutaneous wound is sutured first with 

 button sutures (Fig. 56) and then with interrupted sutures 

 of strong braided silk. At the orifice a stitch or two is taken 

 into the rubber tubing to prevent it from working outward 

 by the respiratory movements. 



Fifth Step. — Strong wraps of muslin are then encircled 



Fig. 248— Dressing in Operation for Penetrant Wounds. 



around the body and fastened securely to prevent slipping. 

 At the orifice a perforation is made in the bandage for the 

 drainage-tube. 



AFTER-CARE. — The patient is sustained on a light, 

 succulent diet. Constipation is combated with linseed oil 

 and rectal injections, and the strength is maintained with 

 ammoniacal stimulants. 



At the end of four days the bandage is removed tempor- 

 arily to treat the wound to a sprinkling of iodoform. The 

 drainage tube is kept open by probing to dislodge desiccated 

 products that accumulate around the opening. In ten days 



