Two suggestions for improving the operation of excision of the knee-joint for strumous disease / by A.G. Miller.

  • Miller, Alexander Gordon.
Date:
[1889]
Catalogue details

Licence: Public Domain Mark

Credit: Two suggestions for improving the operation of excision of the knee-joint for strumous disease / by A.G. Miller. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Two Suggestions for Improving the Operation of Excision of the Knee-Joint for Strumous Disease\ By A. G. MILLER, M.D., F.R.C.S. Ed., Surgeon to the Edinburgh Royal Infirmary. (Read before the Edinburgh Medico-Chirurgical Society, 15th May 1889 ; and reprinted from the Edinburgh Medical Journal for July 1889.) More than twenty years ago, when I was house-surgeon to the late Professor James Spence, I learned that to get a satisfactory result in strumous joints it is necessary to remove the whole of the diseased synovial membrane. To carry out this principle, Professor Spence was in the habit, when operating on the elbow, of cutting away as much of the synovial membrane as he could get with scissors. In operating on the knee he adopted a more thorough procedure, which many members of this Society may remember. This was, after reflecting upwards a semilunar flap of skin, to make a circular sweep with his knife round, and at some distance from the patella, and thus remove in one mass that bone and a considerable portion of the thickened and diseased synovial membrane. This procedure strongly recommended itself to me, and I think that I have even improved on it. My method is as follows:—After reflecting a semilunar flap of skin upwards, well above the patella, I cut through the tendon of the extensor of the thigh a little above the patella, and also through the fibres of the vasti, internal and external. In this way the synovial membrane is exposed, and it is then quite easy, cutting in the cellular tissue covering it, to push up the muscular substance, and to draw down the thickened synovial membrane, which comes readily off the