. Manual of operative surgery. (Chir. du Thorax, Schwartz). Trace the flap XVZW. Open thepleura along the lines XY and WZ. Divide the ribs, intercostal structyres MEDIASTINUM and pleura along the line YZ. Reflect the flap outwards,thoracic operation is finished, replace the flap and suture. 341When the intra- OPERATIONS ON THE POSTERIOR MEDIASTINUM* As the type of operations on the posterior mediastinum, one may takethat of Nassilov, a description of which was published in 1888 and in 1899 byStoyanov. The following description closely follows that of Nassilov: Placethe patient in the ventral o
. Manual of operative surgery. (Chir. du Thorax, Schwartz). Trace the flap XVZW. Open thepleura along the lines XY and WZ. Divide the ribs, intercostal structyres MEDIASTINUM and pleura along the line YZ. Reflect the flap outwards,thoracic operation is finished, replace the flap and suture. 341When the intra- OPERATIONS ON THE POSTERIOR MEDIASTINUM* As the type of operations on the posterior mediastinum, one may takethat of Nassilov, a description of which was published in 1888 and in 1899 byStoyanov. The following description closely follows that of Nassilov: Placethe patient in the ventral or semiventral position. Make an incision at leastthree inches in length along a line parallel to the vertebral column, and fourfinger-breadths from it. From each end of the vertical cut make a horizontalincision towards the spine. Reflect towards the spine the musculo-cutaneousflap thus delimited. Resect the exposed portions of ribs subperiosteally. Thisrequires great care because of the danger of puncturing the pleura. Should. Fig. 437.—{Schwartz.) any pleural wound be inflicted, suture it immediately. The ribs should beresected close to the spine, as this gives most valuable room. The superiorportion of the oesophagus (above the arch of the aorta—Bryant) is accessibleafter excision of portions of the third, fourth, fifth and sixth ribs on theleft side; the inferior portion after resection of three or more of the lower ribs onthe right side. Attend to hemostasis. Carefully separate with the fingers theposterior portion of the pleura from the remnants of the excised ribs attachedto the spine. When operating on the left side, push the lung forwards withthe palm of the hand and fingers; this exposes the thoracic aorta, to the rightof which lies the oesophagus. The oesophagus may be recognized by palpation,and if necessary by a sound being passed into it from the mouth. By bluntdissection with a grooved director separate the loose cellular tissue which en-compasses the aorta,
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