Umbilic Hernia 1055 



Strict antisepsis should be maintained, and the necrotic hernial 

 sac prevented from decomposing or becoming harmfully infected. 

 Usually the necrotic sac drops away within seven to ten days. 

 The atresia of the hernial ring may be furthered and rendered 

 more secure by the continuance of the supporting antiseptic 

 bandage for a few days after the necrotic sac has dropped away. 

 e. Sutures constitute the most radical, and, in our hands, the 

 most satisfactory method for handling umbilic hernia. The 

 sutures may be applied by a great variety of methods. 



In very large hernias it is best to open the hernial sac freely, 

 under general anaesthesia and strict asepsis, and, after denuding 

 the margins of the hernial ring, to pass strong sutures through 

 the margins of the ring and forcibly draw them together. In 

 one instance in our clinic, a yearling filly had an umbilic hernia, 

 the oblong ring of which measured approximately 4 by 8 inches. 

 The animal was secured in the dorsal position upon the table, 

 and anesthetized. With the aid of two assistants, the hernial 

 sac was opened from end to end under strict aseptic precau- 

 tions. By means of a strong needle, sutures were passed through 

 the skin and other tissues into the muscular walls of the abdo- 

 men, and then carried across from one margin of the ring to the 

 point opposite, where they were finally brought out through the 

 skin on the opposite side, some distance from the margin of the 

 hernial ring. The suture was then returned in the opposite di- 

 rection, at a distance of about ^ inch, a piece of rubber tubing 

 passed between the closed end and the skin, and a second piece 

 of tubing laid between the two free euds, which were now tied 

 and drawn sufiiciently tight to bring the two margins of the ring 

 into immediate contact. 



A series of these sutures was applied, sufficient in number to 

 thoroughly close the entire hernial ring from end to end, thus 

 constituting essentially a quilled suture. The hernial sac was 

 excised, and the margins of the skin brought together by ordi- 

 nary interrupted sutures. A broad bandage was then passed 

 around the body of the filly, and a large antiseptic pad securely 

 attached to it, pressing upon the operative area. The pad of 

 absorbent cotton was saturated several times daily with i-iooo 

 corrosive sublimate solution. There was little reaction from the 

 operation, and the suppuration in the wound was trivial in 



