. Text-book of operative surgery . d turned upwards, the sterno-clavicular joiuts opened, and the cajjsule on theleft side is detached from the stermim. The first and second costal cartilages are thendivided close to the sternum, and the sternum is cut across with a chisel below the level ofthe second cartila^e. absent. Injection experiments by Lappe, Poirier, Goldmann, and others, have shownthat after ligature of the inferior vena cava the blood is returned to the heart IIa 104 OPERATIVE SURGERY without difficulty and, tliat of tlie numerous auxiliary anastomoses in existence, theveins in and
. Text-book of operative surgery . d turned upwards, the sterno-clavicular joiuts opened, and the cajjsule on theleft side is detached from the stermim. The first and second costal cartilages are thendivided close to the sternum, and the sternum is cut across with a chisel below the level ofthe second cartila^e. absent. Injection experiments by Lappe, Poirier, Goldmann, and others, have shownthat after ligature of the inferior vena cava the blood is returned to the heart IIa 104 OPERATIVE SURGERY without difficulty and, tliat of tlie numerous auxiliary anastomoses in existence, theveins in and aboiit tbe spinal canal, in the groin and the azygos veins, are theprincipal Channels by which it is elFected. It would seem, therefore, quite legitimate to ligature the vena cava below therenal veins, and even to resect a portion of its length. A case has recently been Right sterno-clavicular Joint. Sterno-mastoid m. Sterno-hyoid and sterno-thyroid in. / Left sterno-\ cla\ ioular Joint. Tnt. mammarj 1a. and v f Innomin-I. ate Eight pleura and lung. Snp. Vena cava. N. Lelt pleura and luujj Body of sternum. Fig. 74.—Osteoplastic resectiou of manubrinm sterni. The sternum is turned over to the right depressors of the larynx are seen detached from the back of the manubrium, The rightand left pleurse and Inngs are exposed bounding the anterior mediastintim. described by Houzel in Avbich the initial disturbance in the circulation was perfectlycompensated. 84. Ligature and Suture of the Innominate Veins. During the removal of deep-seated tumours in the neck, especially in intrathoracic struma, severe hsemorrhageis often encountered from the tearing of deep veins (thyroidea inferior and ima).The bleeding from these veins can be temporarily arrested by pressing the bleeding-point, or the left innominate vein, against the posterior surface of the sternum,while it can be permanently controlled by plugging, where ligature is not possible. SURGERY OF THE VENOUS SYSTEM 165 J
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