A manual of operative surgery . y become over-heated or break. Giglis saw is practically afret-saw. In using it the bone should be sawn obliquely, sothat, in the portion removed, the outer table is larger than theinner, reposition by this means being more accurate. All thefour angles of the bone-flap having been united by the saw-lines,it is turned downwards, with its overlying pericranium and bone may be divided with a chisel instead of by the abovemethod, the bone flap then corresponding in shape with that ofthe soft tissues (see Fig. 213). If the patient now manifests any sign of
A manual of operative surgery . y become over-heated or break. Giglis saw is practically afret-saw. In using it the bone should be sawn obliquely, sothat, in the portion removed, the outer table is larger than theinner, reposition by this means being more accurate. All thefour angles of the bone-flap having been united by the saw-lines,it is turned downwards, with its overlying pericranium and bone may be divided with a chisel instead of by the abovemethod, the bone flap then corresponding in shape with that ofthe soft tissues (see Fig. 213). If the patient now manifests any sign of shock, the flap isreplaced, held in position by three or four sutures, and heis returned to bed, the second step being undertaken in six orseven days time. 42 OPERATIONS ON HEAD AND NECK [part hi The dura mater is now divided around about four-fifths ofthe margin of the aperture in the bone. The incision is madeabout one-eighth of an inch from the bone, so as to leave roomfor suturing. The incision may be conveniently commenced. FIG. 213.—TEMPORAL RESECTION OF SKULL. A, Incision through soft tissues down to the bone ; B, Groove being cut in the bone ; C, Flapof bone and soft tissues turned down en masse. with the scalpel, and completed with slender blunt-pointedscissors. All arteries lying in the line of the proposed incision must betied, and this is most readily done by passing the ligature with afine curved needle in a handle. The brain is now exposed, the chap, i] CEREBRAL TUMOUR 43 flap of dura mater being held aside by a suture passed through itsmargin. The condition of the underlying parts is then is best done by means of the finger-tip, exploration with aneedle being untrustworthy. The consistency of the tumourmay so closely resemble that of the brain substance that it maybe impossible to determine its presence or size until the brainhas been incised. If by these means it is found that the tumour cannot be re-moved, the dura may be replaced, but not s
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