Lectures on orthopedic surgery : and diseases of the joints : delivered at Bellevue Hospital Medical College, during the session of 1874-1875 / by Lewis A. Sayre.

  • Lewis Sayre
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on orthopedic surgery : and diseases of the joints : delivered at Bellevue Hospital Medical College, during the session of 1874-1875 / by Lewis A. Sayre. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    ured tendon or fascia, or any portion of tissue that has undergone structural change, is very liable to be broken. These blades are made of various shapes; some straight, and some curved, with the cutting edge either on the convex or concave border. The sharp-pointed tenotomes usually found in the shops should never be used, as they are liable to puncture tissues which should be unmolested ; and their use in the neighborhood of inrportant vessels and nerves is very hazardous. The next important question is, How are we to determine whether, in any given case, we shall be compelled to resort to tenotomy ? The law, which is of universal application in deciding this question, is the following: Place the part contracted as nearly as possible in its normal position, by means of manual tension grad- ually applied, and then carefully retain it in that position ; while the parts are thus placed upon the stretch, make additional ]3oint- pressure with the end of the linger or thumb upon the parts thus rendered tense, and, if such additional pressure produces reflex contractions, that tendon, fascia, or muscle, must be divided, and the point at which the reflex spasm is excited is the point where the operation should be performed. If, on the contrary, while the parts are brought into their nor- mal position by means of manual tension gradually applied, the additional point-pressure does not produce reflex contractions, the deformity can be permanently overcome by means of constant elas- tic tension, and the more you cut the greater will be the amount of damage done. This is an important law, which you will do well to remember ; for its application, as already remarked, is universal in deciding the question of cutting contracted tissues. Even when the parts can be completely restored to their normal position, by means of manual force gradually applied, if this ad- ditional point-pressure produces pain or spasm, the contractured tissue must be cut before a complete cure can be effected. The next question that arises is, How is the operation to be performed ? 1. By your own hand, or by that of an assistant, put the parts to be cut fully upon the stretch. 2. Make the cut subcutaneously, and thrust the tenotome through the integument at such an angle as will make a valvular incision. {See Fig. 6.)