On excision of the knee-joint / by Richard G.H. Butcher.

  • Butcher, Richard G. H., 1819-1891
Date:
1855
Catalogue details

Licence: Public Domain Mark

Credit: On excision of the knee-joint / by Richard G.H. Butcher. Source: Wellcome Collection.

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    used in the process of Park. If the bones of the leg are also affected at the same time, the outer incision should be pro¬ longed as far as the head of the fibula. Another is made upon the crest of the tibia, by which means we have two lower flaps, one on the inner, the other on the outer side, which flaps are to be dissected and turned down. The posterior surface of the tibia is then to be isolated from the vessels and nerves, as well as from the origin of the gastrocnemius; and finally, all the portions of the diseased bones are to be removed by means of the saw. The process laid down by MM. Sanson and Begin is as fol¬ lows:—They recommend, after half bending the leg, to make a transverse cut from one lateral ligament to the other, and to divide them and the ligament of the knee-cap at a stroke. The joint surfaces of the thigh and shin bone are then easily laid bare; and by continuing the cut, according to circumstances, along these bones, the joint surfaces of one or other bone may be protruded and easily sawn off. Jaeger proceeds in like manner, making upon a transverse cut, nine inches long, which divides the ligament of the knee¬ cap and the lateral ligaments, two side cuts an inch long, of which each is distant about an inch from either end of the transverse cut. The process of Mr. Syme differs from those above in more respects than one. The operator makes in front of the articu¬ lation two semilunar incisions, one above and the other below, which are united together on a line with the lateral ligaments and circumscribe a transverse ellipse, including the patella; he then excises this ellipse and the bone which is comprised within it, divides the ligaments, and opens into the articulation, and exsects in succession the diseased extremities of the femur and tibia. Mr. Fergusson’s directions for the performance of this ope¬ ration are the following: “ An incision between three and four inches should be made on each side of the joint opposite the lateral ligaments, and a third should be carried across the fore¬ part so as to unite the whole like the letter H. The ends of the lateral incisions should be at nearly equal distances above and below the articulation, and that in front should extend over the patella. This bone should now be detached by dividing the textures around it close to its margins, and the soft parts should then be dissected upwards and downwards to a sufficient extent to permit a thorough examination of the diseased bones. And to facilitate this, as well as the future stages of the ope¬ ration, the lateral and crucial ligaments should be divided; the E 2
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