For the past several years we have employed a method of accurate rib approximation which is simple to apply and results in a firm closure with a minimum of post-operative pain. We published a description originally in the chapter on "The Stomach" in the Lewis Practice of Surgery in 1956. Because of continued satisfaction with the method, it is believed that attention should again be called to its use.
Instead of placing encircling catgut or wire sutures completely about the ribs, two or three sets of drill holes are made opposite one another through the center of the flat surface of the upper and lower ribs, and the ribs are then approximated with steel or silver wire ligatures which are placed through each set of holes. An ordinary rowel leather puncher, such as is used to punch holes in the girth of a saddle and can be purchased at any