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.

    301/864 page 285
    blood welliug- up hy the side of tlie ligature, the artery should ou no account be tied at this spot, as the ligature ■would act as a seton iu the vein, and death possihly ensue from phlebitis or pytemia. The ligature, if already passed, should be withdra-wn, pressure applied to the vein, and the artery tied higher up. Where this treat- ment has been adopted, I have never seen anj^ ill results follow the injury. B. AiS'EL's OPEEATIOX is Seldom done except where the Hunterian method is inapiilicable, as for aneurism in the groin, aueiirism of the upper part of the common carotid, &c. Its disadvantages are—1, that the artery is likely to be diseased ; 2, that its anatomical relations are apt to be disturbed by the contiguity of the sac ; 3, that the sac itself is liable to be injiu-ed during the operation, and to become inflamed and supiiurate ; and 4, that the clot which forms iu the sac is of the soft or jiassive variety. 2. The distal LiGAxruE should only be used where the Hunterian or Anel's method cannot be applied. Brasdcn'^s method, which consists in securing the main trunk on the distal side of the aneurism, may lie em]3loyed in aneurism of the carotid at the root of the neck. It copies that method of spontaneous cure in which a clot blocks the artery beyond the aneurism. After the ligature the clot that forms in the artery may extend to the aneurism, which thus becomes filled by a coaguliun ; or the blood- pressm-e in the sac may become so diminished that laminated fibrin is deposited. Unfortunately, however, in practice the blood-pressure in the anemism a]3pears in^ some cases to be increased rather than diminished, [f »rr//'oy/'.9 nif/hod cousists iu Securing two or more of the main branches of the artery on the distal side of the aneurism. It aims at cutting off ]iart of the blood- stream throiigh the aneurism, and so, by reducing the blood-prossiiri', ])romoting the d('i)osition of laminated coagulum. ii lias been applii'd to the subclavian and carotid arterii's for aneurism of the innominate; but the success attending it has not Ix'cn great. The chief risks arc passive eidargement and subsefpient bursting of the sac, or iiif!a,nniiatio7i a,nd sup])ura,tion of the sac. The DoritLK LKiATuriK.—Tiigaturo above and below the sac, eitlii!i-, 1, liy tlw old metliod of first laying the sac o])en iiiid tlicn scciiriiiL;- tin; bleeding ends of the artery ; or, 2, by the method of Antyllus, of firstscciuinf
    digitised image 1
    digitised image 2
    digitised image 3