The principles of surgery and surgical pathology : general rules governing operations and the application of dressings / by Hermann Tillmanns ; trans. from the 3rd German ed. by John Rogers, and Benjamin Tilton ; ed. by Lewis A. Stimson.

  • Hermann Tillmanns
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: The principles of surgery and surgical pathology : general rules governing operations and the application of dressings / by Hermann Tillmanns ; trans. from the 3rd German ed. by John Rogers, and Benjamin Tilton ; ed. by Lewis A. Stimson. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    107/816 page 95
    §30.] LIGATION OF ARTERIES IN TSfiiR'CONTINUiLT-Y.. SUC'JOpi consisted in drawing out the divided extremity of the artery and transfixing it with a needle, which was then given a half or complete turn until the bleeding ceased. After some forty-eight hours the needle was removed. § 30. ligation of Arteries in Continuity.—The ligation of arteries in their continuity is performed for injuries and for pathological condi- tions, notably aneurism. In case of severe hsemorrhage from an artery as the result of a punctured, gunshot, or transverse wound, it used to be iSie custom to ligate the artery at its most accessible por- tion, in the so-called place -of election, proximal to the site of injury. This is not the best plan, on account of the frequency of secondary hsemorrhage from the unsecured wound in the artery after the collat- eral circulation becomes established. At present we search for the point where the artery has been wounded and tie the vessel on the proximal and distal sides of the wound, and then extirpate the injured portion of the vessel lying between the two ligatures and secure any branches which may be given ofiE in the immediate neighbourhood. As described under § 18, the ligation of arteries in their con- tinuity is performed as a prophylactic measure, to diminish or con- trol haemorrhage during an operation upon the region supplied by the artery in question. Under this heading comes, for example, ligation of the lingual arteries in extirpation of the tongue, of the femoral in dis- articulation of the femur, of the axillary or subclavian in disarticula- tion of the humerus. Moreover, the afferent arteries of a part are some- times ligated to check the growth of an inoj)erable tumour, and for elephantiasis—for instance, of an extremity, etc. The operation, which is performed with every aseptic precaution, consists of two parts: (1) The exposure and isolation of the artery, and (2) the application of the ligature. In general it is best to use Esmarch's artificial ischsemia in ligating an artery of an extremity. For instruments we use a medium-sized scalpel, a straight and curved pair of scissors, two toothed thumb forceps, two dissecting forceps, several artery clamps, two retractors, a director, and an aneurism needle, with aseptic silk and catgut ligatures. After carefully washing the field of operation in the usual way, shaving it, and disinfecting it with a three-per-cent. solution of car- bolic acid or of bichloride 1 to 1,000, and placing the part in a convenient position, an incision six to eight centimetres long is made through the skin along the course of the artery. The fingers of the left hand hold the skin firmly stretched, or a fold of skin is lifted up and divided from without inwards, or transfixed and cut from within outwards. The skin is divided by one stroke of the knife. Then the operator and his assistant seize the cellular tissue at two opposite points
    digitised image 1
    digitised image 2
    digitised image 3