Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

    203/864 page 187
    be done is to endeavour to j^revont gangrene occurring hy raaintaiuing the warmth of the limb till the coUaterai circulation has had time to become established. Should gangrene occur amputation must be performed as soon as a line of demarcation has formed, (b). When Mood in large quantities -is exiravasattd intv the tissues the treatment wiU depend on the situation of the ruptured artery. Thus, m the case of the popliteal, amputation is usually called for, especially if the vein is also ruptured, as gangrene, for the reasons stated above, will almost mvanably ensue if the main artery is tied either above or at the seat of ruptm-e. In the case of the axillary, how- ever, where the coUateral circulation is much more free, the ruptiu'ed artery ]nay be cut down upon and secm-ed above and below the bleeding spot. WoTTJOJS OF ^VETERiES may be divided into the pene- tratmg and the non-penetrating. 1. The non-pem-trati)ifj are those in which either the outer only, or the outer and middle coats, are notched or torn. Here the wound may heal, or the uninjured coat or coats may ulcerate, give way, and hasmorrhage ensue, or may gradually yield, as may also the cicatrix left on the heaimg of the wound, to the pressure of the blood, and lead to the formation of an aneurism. 2. The penttruting are those in which the interior of the artery is laid open. In this case much will depend upon tfie .size oi the artery, and whether it is completely or only partially cut across, and upon the direction and size o'f tne wound. (a) . IVoMids of large arteries, as the aorta or pulmonary artery, whatever their nature, are usually immediately (b) . Wfnmds of arteries of the second and tli ird degree, as the femoral and brachial. If the artery is completelii divided, and the edges of the wound arc cleanly cut re- peated hfemorrhages rai)idly terminating in death will generally ensue; but if the edges arc^ uneven and ragged as m the avulsion of a limb by machinery or byacanuon- Uall, tJie external coat becomes twisted up, and the middle and internal retract and contract, a clot forms within the vessel and no haemorrhage occurs. If the artery 'partially divided and the wound is made transversely to the ong axis of the vessel the longitudinal tension of the oiastic coat causes the wound to assume a diamond shaiio, and severe htomorrhage will ensue; but if the wound is
    digitised image 1
    digitised image 2
    digitised image 3