A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior PractitionersBell, Joseph
Science
A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior Practitioners
Bell, Joseph
Surgery, Operative
After they have been fairly tried, the sac of the hæmatocele should be
laid open in its full extent; any large vessels which bleed should be
tied, and the cavity then stuffed with lint. When the lint can be
removed, which will be after two or three days, the edges of the wound
should be brought closely together, and the cavity will then rapidly
heal up from the bottom, and be obliterated by secondary union of
granulations.
In cases where the walls of the cavity are enormously thickened, or
even, as sometimes happens, almost bony in consistence, an elliptical
portion may be removed with advantage.
EXCISION OF TESTICLE.--This operation is rarely required except for
tumours of the testicle. Hence the size of the incision necessary must
vary much with the size of the tumour; and the amount of skin to be
removed (if any) on the amount of adhesions it has formed to the tumour.
One or two points must be attended to in every case of extirpation of a
testicle:--
1. The incision should commence over the cord just outside of the
external ring, and be continued fairly over the tumour to its base.
2. As to removal of skin, some surgeons advise that none should be taken
away, others that a considerable quantity can be spared. There is
certainly less risk of secondary hæmorrhage if a portion be removed,
than when a flaccid empty bag is left. The author invariably removes a
very large quantity of skin if the tumour is large, as there is much
more rapid healing, and the resulting scrotum is much more comfortable
for the patient.
3. The cord should be exposed at the beginning of the operation, raised
from its bed and given to an assistant, who should compress it gently,
not from any fear of its escape into the abdomen, but to prevent
hæmorrhage. If the tumour has been very large and heavy, the cord will
have been much stretched, and if divided too high up, may really give
trouble by its elasticity, unless the above precaution is taken. The
cord then having been divided close to the tumour, the latter is
removed, care being taken not to include the sound testicle in the
removal. All the vessels are then to be tied or twisted, and the
spermatic artery is to be secured alone, not, as used to be the case,
included in a common ligature with the other constituents of the cord.
Secondary hæmorrhage is very apt to occur from small scrotal branches
which may have escaped notice during the operation.
OPERATIONS ON THE ANUS AND ITS NEIGHBOURHOOD.--FISTULA IN ANO.--While
much might be written on the pathology of fistula, and a good deal even
on its diagnosis, a very few words will suffice to describe the simple
and effectual operation for its relief.
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