The operations of surgery : a systematic handbook for practitioners, students and hospital surgeons.

  • Jacobson, W. H. A.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: The operations of surgery : a systematic handbook for practitioners, students and hospital surgeons. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    definite method being followed. Thus, after a railway accident or gunshot injury, the soft parts will be destroyed on at least one sur- face. In amputating for malignant disease, skin flaps must be made use of, transfixion being usually inadmissible, as the muscles should be cut as short and as close as possible to their upper attachments, to minimize the risk of extension and recurrence. Instead of remember- ing the length and size of differently named flaps, the surgeon will have to be familiar with the anatomy of the parts, the position of the vessels, and the best means of meeting haimorrhage. The joint is so well covered that sufficient flaps can* nearly always be provided, while the blood supply is so abundant that sloughing very rarely occurs, and even if it do so, from the results of injury or hospital gangrene, the tissues of the chest will come forward suflici- ently to close the wound. The fact that the cavity of the axilla gives good drainage below is of much importance. The following methods will be described here : in the first two, skin flaps are made; in the others (save in the Furneaux-Jordan method), transfixion is made use of, in part at least. i. By lateral skin flaps. The oval, or en raquette methods. ii. Spence's method. iii. Superior and inferior flaps. iv. Superior or deltoid flap. V. Anterior and posterior flaps. vi. Furneaux-Jordan method. > Means of arresting Hsemorrhage in Amputation at the Shoulder-joint.—These are mainly two : 1. Pressure on the SubclaviAxN.—I am of opinion that the more the surgeon trusts to this plan solely, the more often will he have cause to regret it. Pressure, however well applied at the first with the thumb, aided by a padded ke}^ or a weight, is too often rendered un- certain by the necessary changes in position of the limb during the operation, or by the pressure of assistants, a violent gush of blood at the last showing to the surgeon that his confidence in the artery being secured is misplaced. Furthermore, an assistant so used is neces- sarily much in the way of the others aiding the surgeon. For the above reasons I much prefer trusting to one or other of the two next given. 2. Compression of the Inferior or Anterior Flap, and so of the Vessels before they are cut (p. 123, Figs. 35, 36). 3. Ligaturing or twisting the Vessels on the Inner Aspect of the Limb before they are cut (p. 119, Fig. 33). * In some cases of gunshot injury, it is necessary to get the chief flap from the axillary region, and to bring this np and unite it to the cut margin of skin over the acromion.