Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . the ribs and the pleura, the latter may be opened, if it has not already contingency should be provided for. As the flap is turned forward andinward upon its sternal base, the cartilages are broken near the sternum. The pericardium is picked up with forceps and incised from the lower andouter to the upper and inner aspect of the wound. If need be the incision iscontinued on outward into the pleura. Blood may be removed from thepericardium, and the heart
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . the ribs and the pleura, the latter may be opened, if it has not already contingency should be provided for. As the flap is turned forward andinward upon its sternal base, the cartilages are broken near the sternum. The pericardium is picked up with forceps and incised from the lower andouter to the upper and inner aspect of the wound. If need be the incision iscontinued on outward into the pleura. Blood may be removed from thepericardium, and the heart exposed for operative treatment. This operationmay wisely be done under differential pressure. To prevent irritation of the heart through pericardial stimuli, M. Heitler THE THORAX 427 has suggested applying cocain to the pericardium when it is to be much hand-led (Med. Klinik, Bd. 6, Nr. 25, 1910). See Operations on the Mediastina, page 458, for other methods of exposingthe heart. Cardiorrhaphy (suture of the heart) is done after exposure of the heartby one of the above-described operations or by the operations described for. Fig. 1103.—Wound of first suture. The heart is held in the palm of the hand and steadied by gentlepressure with the thumb. The needle is passed during the diastolic interval betweenpulsations. The heart has been exposed by an osteoplastic flap with its base outward. exposure of the mediastina (page 458). The procedure adopted mustdepend upon the site to be exposed. If necessary to steady the heart a tem-porary fixation suture of silk may be passed through the musculature of theapex. For suturing wounds of the heart the wound should be made freely acces-sible. A full curved needle held in a light needle-holder is used. Fine silk^iscommonly employed. Fine chromicized catgut is, perhaps, preferable. Theneedle is quickly inserted only during diastole. The sutures are placed 3 mm. (3^ to %q inch) from the edge of the wound. The needle sh
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectsurgery, bookyear1920
