. Text-book of operative surgery . LAlIONS 369 attacliments and divided between clamps. Lynn Tiiomass forceps are excellentlyadapted for this piirpose, as the tissues can be transfixed by the small blade. On the basis of experiments and of our vinfortunate experiences with two patients,we sbould proceed as follows in a case of sarcoma of the pelvis, in which conditionalone an interilio-abdominal disarticulation is indicated. The median basilic vein isexjDOsed and everything is prepared for intravenous injection. The patient is placedon a well-warmed Operation table, and an enema of tea and bra
. Text-book of operative surgery . LAlIONS 369 attacliments and divided between clamps. Lynn Tiiomass forceps are excellentlyadapted for this piirpose, as the tissues can be transfixed by the small blade. On the basis of experiments and of our vinfortunate experiences with two patients,we sbould proceed as follows in a case of sarcoma of the pelvis, in which conditionalone an interilio-abdominal disarticulation is indicated. The median basilic vein isexjDOsed and everything is prepared for intravenous injection. The patient is placedon a well-warmed Operation table, and an enema of tea and brandy is administered. An incision is made parallel to Pouparts ligament exactly similar to that usedin ligatnre of the common iliac artery (1 in Fig. 242). (This might be effectedunder local anaesthesia.) The fascia is divided in the form of an angular fiap, themuscles are separated in the direction of their fibres, the fascia is transversalis raisedalong with the peritoneum, and the internal iliac fossa and the common iliac artery. FlGS. 240 and 241.—Lines of section of pelvis in Keen and Freemans cases of amputation of pelvis. are exposed. The artery is temporarily controlled with a suitable compressor or clamp(Halsted), and after the vein has been emptied by elevating the limb, it is alsoclamped. We regard temporary closure of the vessels as a necessary precautionagainst coUapse from acute anaemia. The inner surface of the pelvis is now care-fully investigated, the limits of the tumour are defined, and the proposed lines ofsection of the pelvis determined. The dorsal aspect of the innominate bone is then similarly examined. This ismost satisfactorily effected through an incision in the same direction as that forligature of the gluteal artery (2 in Fig. 242), only cousiderably longer and more likethat we recommend for posterior excision of the hip at the upper border of thegluteus maximus. The great sacro-sciatic notch is thus exposed, and the line atwhich the bone is to be
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