. American practice of surgery ; a complete system of the science and art of surgery . Formerly it was supposed that a segment four or five inches in lengthrepresented the limit of extirpation by the perineal method. The writer has SURGICAL DISEASES OF THE AXIS AND RECTUM. 913 removed, by thi?; nuthocl. a segment more than fifteen inches in length, andhe has cleaned out the sacral cavity as perfectly as he could have done by auvother possible means. He is therefore adopting the method more and morein all operations that do not actually demand abdominal section. (b) Kraskes Parasacral Method.—T
. American practice of surgery ; a complete system of the science and art of surgery . Formerly it was supposed that a segment four or five inches in lengthrepresented the limit of extirpation by the perineal method. The writer has SURGICAL DISEASES OF THE AXIS AND RECTUM. 913 removed, by thi?; nuthocl. a segment more than fifteen inches in length, andhe has cleaned out the sacral cavity as perfectly as he could have done by auvother possible means. He is therefore adopting the method more and morein all operations that do not actually demand abdominal section. (b) Kraskes Parasacral Method.—The term parasacral is employed to in-dicate any method by which access to the rectum is obtained bv either per-manent or temporary sacrifice of any part of the sacrum or coccyx. They areall modifications of Kraskes method, which was first introduced in method consists in simply removing the cocc^-x. Kraske removes thecoccyx and the left corner of the sacrum. Other operatoi-s remove more orless of this bone, as will be seen bv referrins; to the drawings. (Fio- ,37-^. Fig. 376.—Perineal Extirpation. P. Lateral peritoneal folds; T, enlargement of h-mph nodesbetween folds of mesorectum. (Tuttle.) A-H.) Rehn. Rydygier, and Hegar do not remove the bone permanently,but leave it in a skin flap, as \\-ill be described. After the bone has beenremoved and suitabk^ access has been obtained to the rectum posteriorly,these operators all employ the same method of extirpation, and it is unneces-sary to go into any detailed description of this part of the operation more thanonce. \on Heinecke makes a T-shaped incision into the skin, earning it throughthe sacrum and coccyx. Le^y makes a sciuare flap and throws it other operators nearly all use a straight incision from the anus backwardand up to about the level of the third sacral foramen: the} then remove thecoccyx and as much of the sacrum as they believe necessary and vn.—08 914 AMERICAN PRACTIC
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
