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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    tremity of the transfixion incision to the other. The operation is then completed as before. EXCISION OP THUMB AND FINQERS. Removal of Phalanges.—Owing to the exceeding value of the thumb, a phalanx should always be preserved if possible, not only in wdiitlow-necrosis, but in the case of the first or proximal phalanx, w^hen it is the seat of enchondroma. By this, not only is appearance saved by the lessened shortening, but the use of the long flexor, in particular, is preserved. Thus, Mr. Royes Bell (Lancet, 1872, vol. ii. p. 846) published a case in which he excised the proximal phalanx in a woman, aged nineteen, for a huge enchondroma of sixteen years' growth, the joints being movable. The phalanx w^as excised by two lanated incisions over the tumor, the knife kept close to the bone, and the joints opened. No tendons were cut. Eighteen months later the condition of the thumb w^as excellent, both for all general movements and for writing. Removal of Metacarpal Bone.—This should always be ex- cised wherever possible, in preference to sacrificing a part of such incalculable value as the thumb. Sir W. Fergusson {Pract. Surg., p. 322), in speaking of this operation, says that he saw it once per- formed, and, though the organ was far from strong, the patient could use a needle with tolerable facility not long after, and he further remarks that the comparative shortness of the bone re- moved, and the firm cusnfcn of soft parts that remains after its excision, wall make the remaining part useful. In removing the metacarpal bone, a straight incision, which reaches i inch beyond each extremity of the bone, having been made along the dorsum, the tendons are drawn aside; the distal end and joint are next cleared and opened, wdien the bone can be used as a lever whilst it is freed from the soft parts on the palmar aspect and then disarticulated. The radial artery must be remembered both on the ulnar side of the metacarpal bone and by the carpo-metacarpal joint (Fig. 5). Excision of Metacarpo-phalangeal Joint.—This may be very occasionally required in those cases where a dislocation of the first phalanx cannot be reduced, either as a primary operation or later on, in a young and healthy patient, to whom the stiffness is a serious drawback. An incisfon, H inch loiig, on the radial side will leave least scar; the joint is opened, the bones dislocated, or, if this be found diffi- cult, the ends of the bones may be cleared by keeping the knife- point closely applied to them and by retracting strongly the soft