Operative surgery . rimposed tissues from a point located half an inch inside of the anteriorsuperior spine of the ilium to the outer border of the rectus muscle is said(Elliot) to afford more room in this method than does the oblique divisionof these structures. Weir gains the needed room by tearing the denudedfascia of the external oblique from the sheath of the rectus to near its innerborder. He then divides the anterior layer of the sheath transversely to theinner border, in the line of the muscular separation, draws the rectus muscleinward, ligatures the epigastric vessels as they appear
Operative surgery . rimposed tissues from a point located half an inch inside of the anteriorsuperior spine of the ilium to the outer border of the rectus muscle is said(Elliot) to afford more room in this method than does the oblique divisionof these structures. Weir gains the needed room by tearing the denudedfascia of the external oblique from the sheath of the rectus to near its innerborder. He then divides the anterior layer of the sheath transversely to theinner border, in the line of the muscular separation, draws the rectus muscleinward, ligatures the epigastric vessels as they appear in the sheath, cuts theposterior tissue of the sheath and the peritonaeum in a line coiresponding tothe division of the anterior layer. When the borders of the wound are drawnasunder the pelvic cavity can be freely examined. The tissues of the sup-plementary incision are repaired in the reverse of the order of division. Inother respects the wound is treated as heretofore. This measure affords 724 OPERATIVE ample room, with easy and secure repair, and is a valuable adjuvant of theintermuscular separation method. At about the same time JUtttle, Kammerer, and Jalaguier each independ-ently proposed a novel method of approach to the appendix through thesheath of the rectus in relapsing cases. The anterior walls of the sheath andthe superimposed structures are divided vertically at the outer border of therectus muscle (Figs. 9:^3 and 924) ; the tissues at the inner border of the incision, including the rectus muscle, are drawninward with blunt retractors (Fig. 929), thus ex-posing the posterior wall of the sheath and thesemilunar fold of Douglas; through the posteriorwall of the sheath, within half an inch of theouter limit (c), a vertical incision parallel with thepreceding one is made into the peritoneal cavity;the borders of this incision are drawn apart, theintestines pushed aside, and the appendix is ex-posed and removed. The wound is closed in thefollowing manner: Th
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