American Practice of Surgery; A Complete System of the Science and Art of Surgery Volume 4 - Softcover

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This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1908 edition. Excerpt: ...surface are retracted, and the manubrium Fm. 271.--Seeond Stage of Dr. Curtis' Operation... _ (See Fig. 270.) Full exposure of the trachea, innomi-is dlvlded transversely at the June h h I f ' '-. nate artery, arch of t e aorta, and t e e t lnnomi tlon of the upper borders of the nate vein crossing the latter. The right pneumo gastric and the recurrent laryngeal nerves are seen, SL'COI1(l and also VCI'tl(38.lly the latter originating unusually low in this subject. through its centre' The bony (Annals of Surgery, Oct., 1901.) incisions are best accomplished by means of either a Gigli-Haertel saw or by bone-cutting forceps. The two divided halves should be well retracted laterally, and the posterior periosteum incised. The overlying soft structures are displaced to the left, and the inferior thyroid veins are ligated and divided. This process exposes the innominate veins. The left innominate vein should be depressed, and the right innominate vein should, if practicable, be displaced forward and to the right side. Then, after carefully noting the relations of the important nerves and the pleura, the operator should clear the innominate artery, guarding the right pneumogastric artery and the pleura. It is then time to pass the ligature between the artery and the pleura, placing it as far from the aorta as is practicable. The operation need not be carried out subperiosteally. The periosteum can be divided along the bony incisions. By this method less contusion of the tissues is caused and much time is saved. Ligation by Oblique Incisi0n.--The position of the patient and the landmarks are the same as those mentioned in the description of Mott's operation (see page 477). The incision begins at the junction of the middle...

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