A manual of operative surgery . FIG. 475.—EXCISION OF THE SHOULDER, A, Incision of Bauden, Hueters, an3Oilier ; B, Vertical incision ofLangen-beck and others. 750 OPERATIONS ON BONES AND JOINTS [part vii for tuberculous disease it will probably be found that this extendsto some depth into the head of the bone. As much of the latteras can safely be left should be preserved, and it is a good planto make the section slightly convex upwards (see Fig. 474).I (J. H.) have found a chisel and gouge the most convenientinstruments. The glenoid cavity is examined, and its diseased surfacegouged away. The
A manual of operative surgery . FIG. 475.—EXCISION OF THE SHOULDER, A, Incision of Bauden, Hueters, an3Oilier ; B, Vertical incision ofLangen-beck and others. 750 OPERATIONS ON BONES AND JOINTS [part vii for tuberculous disease it will probably be found that this extendsto some depth into the head of the bone. As much of the latteras can safely be left should be preserved, and it is a good planto make the section slightly convex upwards (see Fig. 474).I (J. H.) have found a chisel and gouge the most convenientinstruments. The glenoid cavity is examined, and its diseased surfacegouged away. The skin incision is closed with sutures, andthe limb placed in position. It should be noted that, so long as all diseased bone andsynovial membrane is removed, the insertions of the rotatormuscles should be interfered with as little as possible. Thesynovial pouches in connection with the subscapularis and biceps. FIG. 476.—LINE OF SECTION OF HUMERUS IN EXCISION (<?./.). muscles should be carefully dissected out. If the reflected tendonof the biceps is obviously diseased it should be cut away; some-times it has already been destroyed. When possible, however,it should be preserved. Comment.—This procedure can claim to be the best and themost generally adopted method of excising the shoulder. The capsule is readily reached, the biceps tendon is easilydealt with and protected from hurt, and no injury is inflictedupon the most important muscle of the shoulder—the wound is not well adapted for drainage, but a tube can bereadily passed through a counter-puncture made through theback of the deltoid muscle. The incision described is that ofBauden, Hueter, and Oilier (Fig. 475, a). Langenbecks incision is placed more to the outer side, and chap, v] EXCISION OF THE SHOULDER 751 has for its starting-point the acromio-clavicular joint (Fig. 475, b).No especial advantage appears to have
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