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
The limb being laid as before on the outside, and slightly bent, the
skin shaved and the pulsation of the artery detected, an incision (Plate
I. fig. 6) must be made from the lower edge of the sartorius muscle just
as it crosses the vessel, along the course of the vessel, avoiding if
possible the internal saphena vein.
The sartorius when exposed must be drawn inwards. The fibrous canal
filling the interspace between the abductor magnus and vastus internus
is then recognised, and must be fairly opened; the artery is now seen
lying in it, and over the vein which is posterior to it, but projects
slightly on its outer side; the internal saphenous nerve is lying on the
artery. The needle is best passed from without inwards so as to avoid
the vein. The anastomotica magna is sometimes a large trunk, and has
been mistaken for the femoral in this situation, and tied instead of it.
LIGATURE OF THE POPLITEAL.--This operation is now hardly ever performed
for aneurism, ligature of the superficial femoral having quite
superseded it, and it is very rarely required for wounds, from the
manner in which the vessel is protected by its position.
Before the invention of the Hunterian principle of ligature at a
distance, the old operation for popliteal aneurism consisted in cutting
into the space, clearing out the contents of the aneurismal sac, and
tying both ends of the vessel; from the depth of parts and the close
connection of the popliteal vein, this operation was very rarely
successful, and is now quite given up. If the vessel is wounded the
bleeding point is the object to be aimed at, and is generally sufficient
guide.
In cases of hæmorrhage for suppuration of an aneurismal sac, it might
possibly be advisable, and there are certain cases of rupture of the
artery, without the existence of an external wound, in which attempts
have been made to save the limb by tying the vessel.[10] From the
complexity of the parts, the numerous tendons, veins, and nerves crowded
together in a narrow hollow, and chiefly from the great depth at which
the artery lies, any attempt at ligature is very difficult. It is least
so at the lower angle of the space, where, between the heads of the
gastrocnemius, the vessel comes more to the surface, but is still
overlapped by muscle.
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