. Tri-State medical journal . FIG 3 Fig. i. 468 Original Articles. sew to, we find, as in Fig. 3, that we must depend mainly upon the rectusmuscle or its sheath. This draws the parts so much out of normal relationthat the observer must be sceptical as to their permanent union, (see ) Quite a similar trouble is met in large direct hernias—it being quitedifficult to get tendinous tissue enough properly to fill the gap by a trueplastic operation. As you are aware Waelfler has recently used the sheathof the rectus for closing this gap, but, as his operation is an out and outlaparotomy, and i
. Tri-State medical journal . FIG 3 Fig. i. 468 Original Articles. sew to, we find, as in Fig. 3, that we must depend mainly upon the rectusmuscle or its sheath. This draws the parts so much out of normal relationthat the observer must be sceptical as to their permanent union, (see ) Quite a similar trouble is met in large direct hernias—it being quitedifficult to get tendinous tissue enough properly to fill the gap by a trueplastic operation. As you are aware Waelfler has recently used the sheathof the rectus for closing this gap, but, as his operation is an out and outlaparotomy, and involves no less than eight distinct rows of buried sutures,I think it is more ingenious than practical. This brings me to my own modification, the imbricating or overlap-ping method which I used at first tentatively, but now employ in nearlyevery case. Briefly, this consists in sliding a flap or layer of externalaponeurosis into a position behind the canal so as to reinforce the posterior. Fig. 5. Fig. 6. Fig. 7. Schematic representation of anterior abdominal wall in antero-posterior section, showing threemethods of disposal of the cord. wall, see Fig. 2. This does not do away with the Bassini stitches in the con-joined tendon and transversalis fascia. These parts are still carefully su-tured down to Poupants ligament, but the upper flap of external aponeu-rosis is brought down with them behind the cord, supplementing the pos-terior wall in the most admirable manner. The cord is now replaced. Thelower flap of external oblique is then sutured outside it, to form the ante-rior wall of the new inguinal canal: In the completed operation we thus have three layers of aponeurosiswhere there were formerly but two. Moreover the union of the overlap-ping surface is exceedingly broad and firm, a sort of splicing of layers. The Imbrication Method-Andrews. 469 Not the least of the advantages of this operation is that it shortens ornarrows both walls of the canal. Bassinis operation
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Keywords: ., bookcentury1800, bookdecade189, booksubjectmedicine, bookyear1895
