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.

    315/864 page 299
    of the ai-teiy Ligature of the ulnar in ike upper third is more difficult as it lies beneath the superficial flexor muscles. Make au mcisiou four inches long in a lino ch-awn from the frout of the internal condyle to the radial side of the pisiform bone. Seek the mterval between the flexor carpi uhiaris and the flexor sublimis digitorum. Separate these muscles and the ulnar nerve will be seen. Work superficial to the nerve and the artery wiU be found betwec.n the i^cxor subhmis and flexor p'ofimdus digitorum. Por Collateral circulation see Fig 80 fo, 1 ^^^^^/'^ '.^'t?, ^^I'TERY may reqiiii-e ligatui-e ri\Zi ^^rrT' ™ .^^^ ' - secondary haemor- rhage from the femoral ; 3, a wound of the vessel itself. A Ime drawn from half an incli below and a little to the left of the umbihcus to the middle of Poupart's ligament indicates its com-se Make a curved incision beginmng a httle external to the centre of Poupart's ligament iip- wards and outwards for about three inches towards the anterior superior spine of the ilium (Pi-. 924 c ] Divido he skm, superfici^d and deep fascii, aml the apLem^' of the external oblique, cut more carefully through the mternal obhque and transversahs muscles, and the fascia ransversahs will be exposed. Divide this T a Siec o taking care not to injure the peritoneum. Sei^arate the peritoneum gently from the psoas muscle, aml let an assistant press it carefidly upwards and inwards The artery will now be. felt beating at the inner pa t of the wound along the inner border of the psoas Pass the aneurism needle from within outwards to avoid Srin ' he vem which bes^ to the inner side of the artery The Z fl °^ S«'^ito-crural nerve lies on the crJS^itl^'i 1 r'''r^^'^ ^^^ ^''^ ^leferens cross t just before It passes under Poupart's ligament. Thech^e/accM that may occur during ligature^are 7 At, ° Pei-itoncum; 2, wound of the vein • 3 wound of the spermatic cord ; 4, wound of the epigastric rt ji'Tf t'^^ circumflex ilixc'vS The /ny .i«.^«.,s. after ligature are (iangrene of the hmb; 2, peritonitis; 3, secondary ha,inorrhi,%e. Should muse De tiled. It this fails, nothini-' is loft bnt fh,. desperate expedient of cutting down%n the bloedm vessel and trying to secure it. Davy's lever si oidd n used to control tbe h^omorrhage duH„o Jo m m /; The peritoneum will be probably open^^^.n;;'^;^^^;;^
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