. Gynecology : . Fig. 464.—Nephrectomy. The Incision. rassing difficulties and dangerous accidents. For this purpose a long incisionis necessary. As in making the incision for suspension, one must first determinethe location of the twelfth rib, the outer border of the sacrospinalis muscles, andthe curve of the iliac crest as far as the anterior superior spine. Within the s:i GYNECOLOGY angle niade by the twelfth rib and the muscle border is an area which is softerto the feel than the surrounding parts, and it is in this area that the incisionstarts. It is then carried in a curving sweep toward
. Gynecology : . Fig. 464.—Nephrectomy. The Incision. rassing difficulties and dangerous accidents. For this purpose a long incisionis necessary. As in making the incision for suspension, one must first determinethe location of the twelfth rib, the outer border of the sacrospinalis muscles, andthe curve of the iliac crest as far as the anterior superior spine. Within the s:i GYNECOLOGY angle niade by the twelfth rib and the muscle border is an area which is softerto the feel than the surrounding parts, and it is in this area that the incisionstarts. It is then carried in a curving sweep toward the anterior superiorspine, the length of the incision being determined by the magnitude of the opera-tion. The muscular structures covering the kidney may be opened in a varietyof ways. The superior lumbar triangle may be first exposed and a blunt opening ofthe lumbar fascia made in the manner described for minor operations. This. \vi v! & «\v> e s~—*- Fig. 465.— fibers of the external oblique muscle are being divided preparatory to making the frying pan wound may then be greatly enlarged by cutting downward in the direction ofthe anterior superior spine across the abdominal muscles (external oblique,internal oblique, transversalis) and by cutting upward across the latissimusdorsi and the inferior serratus posticus muscles. Or the muscular structuresmay be cut before opening the lumbar fascia (Tig. 467). Still another method is the frying pan incision of Kelly. A long skin in-cision is made. The abdominal muscles are first opened by splitting the fibers,as in McBurneys operation for appendicitis. The wound is stretched withthe fingers as in Fig. 460). An incision from this opening is then made OPERATIONS OX THE KLDXEY 805 upward through the muscles in the direction of the upper angle of the wound(Fig. 466). When the lumbar fascia is opened the retroperitoneal fat leaps into view, whil
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