The cure of the more difficult as well as the simpler inguinal ruptures.

  • William Stewart Halsted
Date:
1903
Catalogue details

Licence: Public Domain Mark

Credit: The cure of the more difficult as well as the simpler inguinal ruptures. 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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    [313] In the female the round ligament and its vessels is such a small affair that it makes little difference what is done with it. References to the transplantation of the rectus muscle by Wofler: Wofler published his method of transplantation of the rectus in 1892 in the Beitrage z. Festschrift f. Th. Bill- roth. I did not see this publication until my colleague, Dr. Clark, returned from Germaiiy, in June, 1898. My prelimi- nary report had then just been published. For this reason no mention was made of Wofler's work. In the Archiv fiir klin- ische Chirurgie, June, 1898, Dr. Slajmer publishes 150 opera- tions after the Wofler method. A careful reading of these two articles has convinced me that this method of transplan- tation of the rectus differs from mine. In the first place no special reasons are given for the transplanting of the rectus muscle, while in my publication the reason given for the transplantation of the rectus is to strengthen the lower por- [214] tion of the inguinal canal by the introduction of muscle which is weakened by the obliteration of the conjoined tendon. The description of the Wofler method and the illustration on page 912 of the second article show that the rectus muscle is not transplanted in the best way to strengthen the lower portion of the wound, because the sheath of the rectus is not divided down to the symphysis pubis; but the division of the sheath ends at least 2 to 3 cm. above the pubic bone. For this rea- son the transplanted rectus muscle is approximated chiefly over the upper two-thirds of the wound. In addition, Wofler divides the sheath of the rectus on the anterior surface above the linea semilunaris. In my method the sheath of the rectus is divided posteriorly and the belly of the muscle is brought out behind the internal oblique. I believe that by this method the muscle can better be transplanted so as to occupy the lower two-thirds of the wound. Slajmer reports 6 recur- rences, about 6 per cent. In three of these cases the wound suppurated.