. Medical and surgical therapy . ning shouldbe smeared with Horsleys wax, which will attain thedesired result. The same thing may occur during the sawing ofthe bone. Here again the section of the flap mustbe completed, and it is here that the superiority ofmechanical instruments becomes evident, as therebythe operation can be completed in a few seconds. These haemorrhages of the diploe are rare ; a muchmore frequent form of haemorrhage is that producedin the neighbourhood of the trephining when thebone is denuded of pericranium along the line ofthe incision. I shall return to this later on in
. Medical and surgical therapy . ning shouldbe smeared with Horsleys wax, which will attain thedesired result. The same thing may occur during the sawing ofthe bone. Here again the section of the flap mustbe completed, and it is here that the superiority ofmechanical instruments becomes evident, as therebythe operation can be completed in a few seconds. These haemorrhages of the diploe are rare ; a muchmore frequent form of haemorrhage is that producedin the neighbourhood of the trephining when thebone is denuded of pericranium along the line ofthe incision. I shall return to this later on in connec-tion vith occipital and sub-temporal decompression, 820 WOUNDS OF THE SKULL where such haemorrhages are especially serious, hutI wish to point out here that the only means ofstopping them is to drive a small pointed ivory peginto the orifice that is bleeding and then to cut it offflush with the surface of the skull. Injury to the dura mater and the brain with GigWs saw.—This accident will not occur if the trephine holes. Fig. 44.—Giglis saw has been passed under the base of the flap, butthe dura mater separator is too narrow ; it is unsteady in thetrephine holes; the saw does not rest on it firmly, and may cutthe brain. are not placed too far apart, and if care is taken touse a dura mater separator adapted to the trephinewith which the holes are made, and especially ifwatch is kept to see that the protective portion ofthe dura mater separator is well placed. As thesaw represents the chord of the arc of bone whichit has to divide, its tendency to penetrate into thebrain will be greater the more convex the arc or themore distant the trephine holes from each other(fig. 25). If a large trephine is used and a narrow TRUE CRANTECTOMY j^zi dura mater separator, the protective portion of thelatter moves about in the holes, and the saw mayslip off the instrument and lie on the dura materin places (fig. 44), but even in this event, if care hasbeen taken at the beginning of the
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
