. The diseases of children : medical and surgical. hermeans of allowing the surfacesof the abscess sac to cometogether. For this purpose re-section of one or more ribs (Est-landers operation) has beendevised. Although in children,from the softness and flexibilityof the ribs and spine, the chestgenerally falls in readily, this isby no means always the case, and the operation should be done as soon as itis clear that progress is not being made or the childs health is there is an insufficient opening for drainage, it is also necessary insome cases to provide a larger orifice by remo
. The diseases of children : medical and surgical. hermeans of allowing the surfacesof the abscess sac to cometogether. For this purpose re-section of one or more ribs (Est-landers operation) has beendevised. Although in children,from the softness and flexibilityof the ribs and spine, the chestgenerally falls in readily, this isby no means always the case, and the operation should be done as soon as itis clear that progress is not being made or the childs health is there is an insufficient opening for drainage, it is also necessary insome cases to provide a larger orifice by removal of part of a rib ; and,indeed, it is a good practice to excise a portion of rib in all cases where thechild is not so feeble as to make even this slight addition to the severity ofthe operation undesirable. The operation is a simple one ; to remove asingle rib, the lowest one in the cavity should be chosen, usually the seventh Estlanders operation is strictly the removal of a sufficient part of the chest wall toallow of complete collapse. C C. Fig. 73.—Deformity of Chest due to Empyema. 386 Diseases of the Respiratory Apparatus or eighth. An incision is made along it down to the bone, the periosteum isreadily peeled back with a raspatory, and about an inch or more of the rib iscut out with bone forceps ; the periosteum and pleura are then incisedparallel with and avoiding the intercostal vessels ; if the artery is wounded,however, it is easily secured now that the rib is gone. When the resectionis done to allow collapse of the chest wall, from two to five ribs may have tobe resected, two or three inches of bone being taken from each ; in suchcase a quadrilateral flap of the soft parts should be turned forward and theribs removed one after the other. Though it is perhaps better in such casesto remove the bones subperiosteally, the periosteum should be cut awaybefore closing the wound, otherwise it often happens that ossificationrapidly takes place and fills up the gap in t
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