Excision of the knee joint : a description of a new apparatus for the after treatment ; with illustrative cases / by Patrick Heron Watson.

  • Watson, Patrick Heron, Sir, 1832-1907.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Excision of the knee joint : a description of a new apparatus for the after treatment ; with illustrative cases / by Patrick Heron Watson. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    raising a long flap from the anterior surftxce of the articulation. The one exceptional case in whicli I employed an elliptical incision, crossing the front of the joint, and including the patella within its limits, was one in which the operation was practised on account of compound comminuted fracture of the patella. Here the lacerated condition of the integuments, together with the necessity to effect the removal of the comminuted bone^ made this method preferable to any other. In employing the long anterior flap as a means of gaining access to the articulation, I have preferred it for four reasons, chiefly:—1. That while it opens up the parts to be dealt with to both sight and touch more thoroughly than any other, it is easily and rapidly mapped out by a single curvilinear sweep of the knife. 2. That when its extremities are carried behind the line of the condyles they form a complete and efficient drain for the whole extent of the cavity formed by the excision. 3. That its margin corre- sponds in a less degree than any other to the line of section of the osseous surfaces. 4. That the flap so raised will serve for amputa- tion of the thigh through the condyles, should the state of the joint render that advisable after excision has been completed. The H incision, the simple transverse incision, the lateral incisions, both straight, or one straight and the other curvilinear, I have employed on several occasions in operating upon the dead body, but none of them have seemed to me to possess any such superiority over the long flap as to lead me to employ it in practice. They have certain advantages, it is true, which I readily gi-ant, such as admitting in the case of the H, the transverse, or the elliptical incision, a more easy removal of the mere patella, if that is thought essential or desir- able in any given case ; but as I have always attempted to retain the patella where this is possible, incisions specially suited to favour its easy removal have not seemed to me to possess any advantage in this operation.' If the articular surface of the patella is affected by disease, ' In cases of extensive synovial disease, where it is deemed expedient to effect the removal of the altered synovial tissue to as great an extent as pos- sible, this is easily effected by the long semilunar flap. In performing the operation with this object in view, tlie flap raised should consist of skin and