Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
_Torsion._--This method is seldom employed except for comparatively
small vessels, but it is applicable to even the largest arteries. In
employing torsion, the end of the vessel is caught with forceps, and the
terminal portion twisted round several times. The object is to tear the
inner and middle coats so that they curl up inside the lumen, while the
outer fibrous coat is twisted into a cord which occludes the end of the
vessel.
_Forci-pressure._--Bleeding from the smallest arteries and from
arterioles can usually be arrested by firmly squeezing them for a few
minutes with artery forceps. It is usually found that on the removal of
the forceps at the end of an operation no further hæmorrhage takes
place. By the use of specially strong clamps, such as the angiotribes of
Doyen, large trunks may be occluded by pressure.
_Cautery._--The actual cautery or Paquelin's thermo-cautery is seldom
employed to arrest hæmorrhage, but is frequently useful in preventing
it, as, for example, in the removal of piles, or in opening the bowel in
colostomy. It is used at a dull-red heat, which sears the divided ends
of the vessel and so occludes the lumen. A bright-red or a white heat
cuts the vessel across without occluding it. The separation of the
slough produced by the charring of the tissues is sometimes attended
with secondary bleeding.
_Hæmostatics_ or _Styptics_.--The local application of hæmostatics is
seldom to be recommended. In the treatment of epistaxis or bleeding from
the nose, of hæmorrhage from the socket of a tooth, and sometimes from
ulcerating or granulating surfaces, however, they may be useful. All
clots must be removed and the drug applied directly to the bleeding
surface. Adrenalin and turpentine are the most useful drugs for this
purpose.
Hæmorrhage from bone, for example the skull, may be arrested by means of
Horsley's aseptic plastic wax. To stop persistent oozing from soft
tissues, Horsley successfully applied a portion of living vascular
tissue, such as a fragment of muscle, which readily adheres to the
oozing surface and yields elements that cause coagulation of the blood
by thrombo-kinetic processes. When examined after two or three days the
muscle has been found to be closely adherent and undergoing
organisation.
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