Annals of surgery . minute, cuts the bone with practically no pressure onthe part of the operator. As to the mere cutting of the bonethe question of time is eliminated. The greatest care, how-ever, should be exercised in the final stages of the is true that the tactile sense with this instrument is pre-served, and surgeons have expressed the opinion that theycould tell when they have entered the skull cavity withoutthe use of the guard. I would advise, however, the takingthe time with finely-graded adjustments of the guard toprevent injury to a dura intimately attached to the bone.
Annals of surgery . minute, cuts the bone with practically no pressure onthe part of the operator. As to the mere cutting of the bonethe question of time is eliminated. The greatest care, how-ever, should be exercised in the final stages of the is true that the tactile sense with this instrument is pre-served, and surgeons have expressed the opinion that theycould tell when they have entered the skull cavity withoutthe use of the guard. I would advise, however, the takingthe time with finely-graded adjustments of the guard toprevent injury to a dura intimately attached to the bone. 164 H. C MASLAND. In my judgment the chief necessity for this care is to obviatehsemorrhage by cutting a dural vessel. True it is preferableto cut the dura subsequently inside the line of the boneincision to facilitate suturing, but the only ill effect arisingfrom simple cutting of the dura by the saw would be themore troublesome subsequent suturing. Hernia cerebriconsidering the perfect bony support, is It is evident that this instrument, notwithstanding itsability to make a flap superior to all others, must still be ableto cut the bone with as little or less injury to the sublyingtissues than the best of the others, to entitle it to recogni-tion as being distinctly superior. The method just described will accomplish this betterthan any other instrument yet devised with the exceptionof the Cryer drill. I believe however that with the use of SAW FOR OPENING CRANIAL VAULT. 165 the inside guard on my saw, the dura can be protected frominjury with absolute certainty. Using this method theoutside guard is discarded. The skin section is made asbefore mentioned. At the two superior angles of the flap,preliminary openings are made about 3-16 of an inch indiameter, the guard, detached, is then entered in the openingand the dura pressed away from the inner table of the saw is now used to cut two grooves in the bone chieflyto the outer side of the opening and almos
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
