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.

    299/864 page 283
    tion where the artei'j' is closed n,t the seat of the aneurism, also by collateral chairaols; and then again enters the main arterj'. Treatment after lif/ature.—The limb should be com- pletely swathed in the cotton-wool and flannel bandages (which, before the operation, should have akeady been carried up as far as the seat of the ligatiu'e), and ke^st at perfect rest. In the case of poplitoal aneruism, the limb should be slightly raised on a pillow, and placed on its outer side, with the knee a little flexed. If the weather is at all cold, hot bottles should be applied, near, but not in contact with, the limb, care being taken that no l^ressure is made on the heel, malleoli, or other points of bone, for fear of local sloughing. The patient must be kept in bed till the anemism is thoroughly consolidated, and the operation wound has healed. The D.iJSGEES of ligature.—These are—(a) secondary hremorrhage; (b) gangrene ; (c) recurrent jnilsation; (rf) suppuration and sloughing of the sac ; (e) phlebitis; (/) great enlai'gement of the anemism without pulsation : and {(/) the other dangers that may attend any cutting- operation. (a.) Secondarij hccmorrJiage is liable to occur at any period before the wound is soundly healed. The causes, symjitoms, and treatment, are discussed rmder Htemor- rhage, see p. 124. (&.) Oangrene is more common in the leg than in the ann; indeed, in the latter situation it is very rare. It may be due to—1, _failm-e of establishn-icnt of the collateral • ■irculation, when it usually supervenes within a few days; or _ 2, venous obstruction, the result of plugging of the vein in conseqvionco either of injury at the time of operation, or of pressure on the vein by a swollen and suppurating sac. TNHien due to the latter conditions, it may lie d(;layed for some weeks. When extensive and spreading rajiidly, a.mputiition at the seat of ligature must be performed. The surgpon, however, should not be in too much haste to amputate, as the gangrene may involve f'uly a toe er two, or part of tlio foot, and s})r(3ad Jio iurther. When, therefore, it is limited in extent, and spr(;a(Hng slowl,y, a, liii^ dl' demarcation sliould bo waited for before ani])utatio7i is ])i;rfornied. When the sac is very Ijirgc, iuid tlie gangrene ap])cars due to pressure oji the vein, tlie sac may at times be opened with advantage, the clots turned out, and any bleeding vessels secured.
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