A Treatise on Fractures, Luxations, and Other Affections of the BonesDesault, P.-J. (Pierre-Joseph)
Science
A Treatise on Fractures, Luxations, and Other Affections of the Bones
Desault, P.-J. (Pierre-Joseph)
Dislocations; Fractures; Surgery
30. From this comparison of the indications (16) with the means
destined to fulfil them, it appears that there were material defects on
the part of the latter. Let us examine whether or not that of Desault
was better calculated for the purpose. It is, so to speak, nothing but
a modification of the apparatus of Petit (27), but such a modification
as amounts to an improvement in principle, and entitles it to be called
the apparatus of Desault.
31. The pieces which compose it are; a compress two inches broad, and
long enough to reach from the lower part of the thigh to the distance
of four inches beyond the foot; a roller five or six yards long and
two inches wide; a sufficient quantity of lint; and two long graduated
compresses.
32. Every thing being ready;
1st, An assistant supports the foot and leg, the former in a state of
great extension, and the latter half-flexed: another assistant supports
the thigh, grasping it about its middle.
2dly, If there be a wound of the integuments, a little lint wet with
vegeto-mineral water is laid directly over the division of the tendon;
if it be a simple rupture, this precaution is unnecessary. Under the
foot, up behind the leg, and the lower part of the thigh, is then
extended the long compress, which is to be secured in that situation by
the hands of the assistants.
3dly, The hollows situated at the sides of the tendo Achillis, are
then filled up with pledgets of dry lint, surmounted by the two long
graduated compresses, which retain the pledgets, and must project a
little beyond the tendon, because they are liable to be rendered flat
by pressure.
4thly, The surgeon now taking the roller, makes at first several
circular turns round the toes, fixing the long compress there, the end
of which, being reflected over these first casts, is secured by a few
additional ones which cover the whole foot, and are afterwards directed
obliquely above and below the division, round which is formed a kind of
figure of 8, that brings the edges of the wound into perfect contact.
If there be no wound of the integuments, it is necessary to take care,
lest the skin interposing between the divided ends of the tendon,
should separate them, and thus prevent their reunion. Ascending, then,
by circular casts, along the whole leg, and even to the lower part
of the thigh, the surgeon there turns down the upper end of the long
compress, and securing it by a few more circular casts, finishes the
application of the roller.
5thly, The apparatus being thus applied, and the extension of the foot
and the flexion of the leg firmly secured by it, the leg is then placed
on a pillow or bolster, one side of which corresponding to the angle
which the leg forms with the thigh, assists in keeping it half-flexed.
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