. Manual of operative surgery. lis. (B) The above incisions may not providesufficient drainage for the joint cavity nearthe popliteal space, hence it may be necessaryto supplement them by postero-lateral incisionson one or both sides. These are, under the^^wm ??/ li I **^^ circumstances, mere counter-openings. A?^^ m \ v>., f postero-lateral counter-opening is conven- iently made as follows: Pass a closed forcepsthrough the antero-lateral wound (Fig. 1278),through the joint and make it raise up thesoft parts on the outer side just anterior tothe hamstrings, thus avoiding the externalpoplite
. Manual of operative surgery. lis. (B) The above incisions may not providesufficient drainage for the joint cavity nearthe popliteal space, hence it may be necessaryto supplement them by postero-lateral incisionson one or both sides. These are, under the^^wm ??/ li I **^^ circumstances, mere counter-openings. A?^^ m \ v>., f postero-lateral counter-opening is conven- iently made as follows: Pass a closed forcepsthrough the antero-lateral wound (Fig. 1278),through the joint and make it raise up thesoft parts on the outer side just anterior tothe hamstrings, thus avoiding the externalpopliteal nerve; on the inner side it may gobetween the tendons. With a knife makea longitudinal cut so as to expose the forceps,seize the end of a rubber tube in the forceps and with it pull the tube downto but not into the wound in the synovialis. Do not permit any tube to bein the joint as it is certain to injure the synovialis disastrously. Postero-lateral incisions may and often are made as the primary incision, especially. Ftg. 1278.—Drainage knee. Coun-ter opening being made. The tubeshown should not penetrate thesyqovialis. (Labry.) ARTHROTOMY IO27 in cases of pyarthrosis, as they by ihemselves give good access not only tothe joint, but also to those popliteal bursae which most commonly communicatewith the joint. The operation is as follows: (a) On the outer side. Step I.—Extend the knee. Palpate the tendon of the biceps. Make anincision about 2}^^ inches long, just in front of, and parallel to the cut extends nearly down to the head of the fibula and divides the skin andfascia. Step 2.—Slightly flex the knee so as to expose the anterior border of thebiceps tendon. Retract the tendon backwards and expose the posterior borderof the external condyle of the femur. Step 3.—Open the capsule. Introduce the gloved finger into the joint and^guided by it, enlarge the opening as may be necessary, (b) On the inner side. Step I.—The knee being extended, flex the thig
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