. Medical and surgical therapy . n\ Fig. 45.—Crucial incision to expose the vessels of the neck. a pulsating haematoma ceases to beat on temporaryocclusion ot the carotid, it is certain that the haema-toma is of carotid origin. If it continues to pulsate,the lesion is probably in the vertebral. It is best tomake certain by digital compression at the bottom ofthe wound exactly over the foramen in the transverseprocess of the sixth cervical vertebra. If the pulsa- WOUNDS OF VESSELS OF THE NECK Ifto tions cease, lesion of the vertebral is certain. Itoccasionally happens that transmitted pulsation
. Medical and surgical therapy . n\ Fig. 45.—Crucial incision to expose the vessels of the neck. a pulsating haematoma ceases to beat on temporaryocclusion ot the carotid, it is certain that the haema-toma is of carotid origin. If it continues to pulsate,the lesion is probably in the vertebral. It is best tomake certain by digital compression at the bottom ofthe wound exactly over the foramen in the transverseprocess of the sixth cervical vertebra. If the pulsa- WOUNDS OF VESSELS OF THE NECK Ifto tions cease, lesion of the vertebral is certain. Itoccasionally happens that transmitted pulsations aremistaken for true pulsations, the hsematoma being ofpurely venous origin, due to lesion of the jugular Fig. 46.—Exposure of the vessels of the neck. The true state of the case is not perceived until afterincision of the hsematoma. The second stage of operation consists in the freeincision of the haematoma. To remove the bloodand clots is the work of a few seconds, and the woundis well sponged out, when the wound in the vessel isusually easy of discovery. (a) Wound of the internal jugular vein.—Thevessel is dissected out and ligatured above and below iGG \voryi)s OF the vessels the wound ; if necessary, tlic intervening portion isdivided. It is sometimes necessary to ligature thevein at the junction of the great thyro-facio-Jingualbranches. In such a case the latter should also betied, either en bloc or each brancii separately. Ligature of the internal jugular is a simple, certain,and safe operation. I use the word safe advisedly,for the cerebral complications which were formerlyattributed to this ligature arc quite exceptional un-less infection is present. The case described byL. B
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
