A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . ahorseshoe shape, with its convexity downward when the patient isrecumbent, so that during the after-treatment the drainage may be 1 See Operative Surgery of the Human Brain, bv John B. Boberts. P. Blakiston,Son & Co., 1885. 394 FRACTURES. free. If a wound previously exists it may be enlarged. The knifeshould divide the scalp and periosteum at the same time in order thatall the soft structures may be raised in one layer. If any
A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . ahorseshoe shape, with its convexity downward when the patient isrecumbent, so that during the after-treatment the drainage may be 1 See Operative Surgery of the Human Brain, bv John B. Boberts. P. Blakiston,Son & Co., 1885. 394 FRACTURES. free. If a wound previously exists it may be enlarged. The knifeshould divide the scalp and periosteum at the same time in order thatall the soft structures may be raised in one layer. If any periosteumremains attached at the seat of operation, it should be pushed back withthe knife handle. In trephining for epilepsy, cerebral abscess or tumorthe periosteum need not be removed except at the point where thecrown of the trephine is applied. Indeed a circular incision in it thesize of the disk to be removed is all that is needed. When the asepticbutton of bone is to be replaced in the gap, the periosteum upon itsupper surface may be utilized for holding sutures passed through itand then through the periosteum at the margin of the opening. Fig. Authors conical aseptic trephine with solid stem and disk with center-pin, instead of the usualcenter-pin sliding in hollow stem. In fractures the trephine crown must be placed on solid and unde-pressed bone with about one third of the crown overlapping the por-tion to be elevated. If the latter precaution is not observed, abridge of solid bone will be left, which will prevent the application ofthe elevating lever. Elevation and extraction are often facilitated byremoving a disk at the least depressed edge of the depressed trephine should be semi-rotated from left to right and right toleft, with moderate pressure against the bone. As soon as the grooveis made sufficiently deep to maintain the cutting edge in position, thecenter pin is retracted or the center pin disk removed lest it shouldperforate the inner ta
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