Endo-aneurysmorrhaphy (Matas) in the treatment of traumatic aneurysm of the femoral artery / by J.M. Elder.

  • Elder, John Munro, 1859-
Date:
1908
Catalogue details

Licence: In copyright

Credit: Endo-aneurysmorrhaphy (Matas) in the treatment of traumatic aneurysm of the femoral artery / by J.M. Elder. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    262 J. M. ELDER. About one month later he began to complain of pain in the knee and soreness at the site of injury. His physician again examined the limb and found a tumor about the size of a Tan- gerine orange, situated under the scar of the former wound. The tumor was very tense and resistant (non-fluctuating) and no pulsation could be detected in it, but the stethoscope revealed a well-marked systolic bruit when placed lightly over it. The case was watched for eleven days, and it was noticed that the tumor increased rapidly in size and became softer and more fluctuating. The pain in the knee also grew steadily more severe and the lad could not extend the knee joint. On admission to the hospital on September i ith the patient lay on the right side with right knee semi-flexed and supported on a pillow. The pulse was 84, temperature 100° F. A well- marked tumor was visible along the inner and posterior aspect of the right thigh at upper level of popliteal space. Examination confirmed the facts above noted by the family physician, and in addition there was noted much diminished pulsation in the right posterior tibial artery but no other signs of circulatory disturb- ance; there was local tenderness and heat over the tumor but no redness. Leucocyte count, 13,500. A diagnosis of aneurysm was made and operation was car- ried out next day. Operation.—A vertical incision, three inches long, was made over the tumor, and we at once came down upon a fluctuating swelling about the size of a Florida orange. A director intro- duced through the capsule showed the contents of this cyst (for such it evidently was) to be dark blood. An Esmarch was applied to the thigh higher up and all bleeding controlled. The contents of the sac, consisting of thick, dark blood-clot, were then turned out, the quantity being about four ounces. The cyst wall, or sac, was evidently composed of connective tissue only, and upon swabbing the interior the artery was seen lying at the bottom of the sac, and in the vessel wall was an oval opening measuring ^x^ cm. (Fig. I). Bright red blood spurted through this opening when the tension of the Esmarch was relieved. As soon as the parts were quite dry (as Matas insists upon) this opening was closed by three sutures of fine silk, a small, round, curved needle being used and care being taken to
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