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
NOTE.--While, as a matter of surgical principle to guide our
practice on the living, I still hold very strongly the opinions
here expressed against special operations for ligature of the
arteries of the leg, and allow the sentences to stand as in the
first edition of this work, I insert in a note a brief description
of the more important ones, in deference to the advice of friends
and the urgent request of pupils, as these operations are used by
Examining Boards as tests of the operative dexterity of
candidates:--
1. ANTERIOR TIBIAL ARTERY IN LOWER HALF OF LEG.--_Anatomical
Note._--This vessel is related on its tibial side to the tibialis
anticus, and on its fibular, to the extensor longus digitorum
above, and the extensor pollicis below. The anterior tibial nerve
lies first on its outer side, then crosses the artery, and
eventually reaches its inner side near the foot. _Operation._--An
incision, at least three inches long, parallel with the outer edge
of the tibia, and about three-quarters of an inch from it, exposes
the deep fascia. This being divided, the outer edge of the tibialis
anticus must be found, and will be the guide to the artery, which,
surrounded by its venæ comites, lies very deeply between the
muscles.
2. Posterior Tibial.--_A._ In middle third of leg. Here the artery
is separated from the inner border of the tibia, by the flexor
longus digitorum, and is covered by the soleus. _Operation._--An
incision at least four inches long, along the inner margin of the
tibia, exposes the edge of the gastroenemius; then divide the
tendinous attachment, then expose the soleus, and divide its
attachment also; the deep fascia will then be seen; slit it up, and
the vessel will be found about an inch internal to the edge of the
bone. The nerve is there just crossing it.
Guthrie's, or the direct operation, has the very high authority of
the late Professor Spence in its favour. An incision through skin
and fascia in the middle of the back of the leg allows the two
heads of the gastrocnemius to be separated to the same extent. The
soleus is then to be scraped through in same direction, and its
deep aponeurotic surface carefully slit up. The artery and vein are
then easily seen.
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