. Medical and surgical therapy . Fig. 56.—Auvrays method for reaching the upper surface of theliver (Guibe). (A) Parietal incision ; the dotted curve shows theline of section of the costal cartilages ; {B) the scalpel applied closelyto the deep surface of the cartilaginous flap to avoid the pleura anddetach the diaphragm. large intestine by exposing it and making the artificialanus, which we have condemned as regards the smallintestine. Such results as have been published are, asa rule, highly unsatisfactory. But the high mortahtyis due to the fact that this expedient is only resorted PENETRAT
. Medical and surgical therapy . Fig. 56.—Auvrays method for reaching the upper surface of theliver (Guibe). (A) Parietal incision ; the dotted curve shows theline of section of the costal cartilages ; {B) the scalpel applied closelyto the deep surface of the cartilaginous flap to avoid the pleura anddetach the diaphragm. large intestine by exposing it and making the artificialanus, which we have condemned as regards the smallintestine. Such results as have been published are, asa rule, highly unsatisfactory. But the high mortahtyis due to the fact that this expedient is only resorted PENETRATING WOUNDS 503 to when every moment gained is very valuable, thatis to say when the general condition of the patient isvery serious. What we have to remember is that,as Quenu advises^ we should make the special lumbarincision, through which the loop to be exposed will. Fig. 56.—(C) The diaphragm being incised as well as the perito-neum, the hand hooks up the liver to permit access to its uppersurface. , pass, as far back as possible. The preliminary detach-ment of the mesentery might be advantageous. In a case of urgency we might equally well haverecourse to the following procedure : resection of a seg-ment of the colon, closing up and enclosure of the distal 50i WOUNDS OF THE ABDOMEN end, and opening of the caecal end at the skin (Bouvierand CaudreHer, two cases, two deaths). Unilateralexclusion of this kind and the entero-anastomoseswhich accompany them are only to be resorted to underexceptional circumstances. (c) Liver.—Easy access to the dome of the liver isobtained by Auvrays method, of which we will givea brief description ^Fig. 56). An incision leadingfrom the xiphoid cartilage to the tip of the eleventhrib passing by a fingers breadth above the costalmargin ; laying bare of the costal cartilages, incisionby the bistoury, beginning at th
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
