Part 20 (1/2)

The sutures may be soiled by the hands of nurses and a.s.sistants, or the fingers of the surgeon. All these things may be safeguarded, but the operation may have been required for the removal of infected cysts, or pelvic peritonitis: in these cases it is wise not to bury sutures.

Troublesome buried sutures should be removed. In many instances this is easy of accomplishment, and in others it requires patience and often perseverance, even when the patient is under an anaesthetic. The simplest implement for removing a buried suture is a crochet-hook.

The disadvantage of st.i.tch-abscesses, apart from the inconvenience they cause patients during their convalescence, is that they often cause the scar to yield at that spot, and necessitate the wearing of an abdominal belt. If the hernia is of small extent, and especially when it is situated near the lower angle of the scar, it is difficult to fit a belt which will restrain it without the use of perineal bands or straps. In such cases a truss, on the principle of those employed for inguinal hernia, is more satisfactory than a belt.

Occasionally a scar forms a raised hard red keloid band, and causes some anxiety to the patient. These keloid scars shrink and whiten in the course of a year or eighteen months.

=Cancer of the cicatrix.= Several cases have been recorded in which, after the removal of an ovarian adenoma, a new growth, described as 'cancer of the cicatrix', has formed in the scar. These growths are probably due to the soiling of the wound at the time of operation with epithelial fragments from the tumours.

After abdominal hysterectomy for cancer of the body of the uterus, or its cervix, the abdominal wound may become infected with this disease, and in cases where exploratory cliotomy has been performed for diffuse cancerous disease of the peritoneum the cicatrix is liable to become permeated by malignant disease also.

REFERENCES

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BARTLETT, W., AND THOMPSON, R. L. Occluding Pulmonary Embolism. _Annals of Surgery_, 1908, xlvii. 717.

BLACKER, G. F. _Lancet_, 1909, i. 395.

BLAND-SUTTON, J. Hunterian Lecture on Thrombosis and Embolism after Operations on the Female Pelvic Organs. _Lancet_, 1909, i. 147.

BLAU, A. Ueber die in der Klinik Chrobak bei gynakologischen Operationen beobachteten Nebenverletzungen. _Beitrage f. Geb. u. Gyn._, 1903, Bd. vii. 53.

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JONAS, E. Temporary Uretero-v.a.g.i.n.al Fistula after Panhysterectomy for Fibroid of the Uterus. _Am. Journ. of Obstetrics_, 1907, lvi. 731.

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LYLE, RANKEN. A Series of Fifty Consecutive Abdominal Sections. _Journal of the British Gynaecological Society_, 1906-7, xxii. 120.

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