13. Once the bullet was successfully located and extracted, control of bleeding was necessary. An instrument called a tenaculum is used by the surgeon on the left to hold up the ends of arteries and veins so that the surgeon on the right can ligate or tie off the blood vessels with suture material.

A piece of the suture or "tail" was allowed to hang out of the wound after it was closed. When the surgeon felt that the wound was healing properly, the tailed was yanked off so that this foreign body would no longer remain inside the wound. If the blood inside the vessel had clotted properly and the clot had retacted and become secure, bleeding would not occur. If the massive innoculum of bacteria introduced during the surgery infected the blood vessel sufficiently, the clot would not proerly retract and dislodging the ligature resulted in massive, sometimes fatal, "secondary hemorrhage".