The surgical assistant, a manual for students, practitioners, hospital internes and nurses . en clamped, the assistant inserts sharpretractors in the skin wound and then, after their division, inthe fascia and in the aponeurosis (linea alba). In this waythe preperitoneal tissues and the peritoneum are exposed. 184 Abdominal Operations. 185 If the aponeurosis is divided just to one side of the lineaalba, i. e., through the rectus sheath, the assistant employshis retractors in a manner similar to that described below forthe trap-door incision. Direct incision through the muscles.—The assistant i
The surgical assistant, a manual for students, practitioners, hospital internes and nurses . en clamped, the assistant inserts sharpretractors in the skin wound and then, after their division, inthe fascia and in the aponeurosis (linea alba). In this waythe preperitoneal tissues and the peritoneum are exposed. 184 Abdominal Operations. 185 If the aponeurosis is divided just to one side of the lineaalba, i. e., through the rectus sheath, the assistant employshis retractors in a manner similar to that described below forthe trap-door incision. Direct incision through the muscles.—The assistant is toexpose each tier of muscles (external oblique, internaloblique, transversalis), in order, inserting his retractors intothe layer last divided. Vessels should be clamped as they arecut, or ligated in continuity when they are exposed beforedivision. Nerves that can be spared should be drawn asidewith the retractors. Intermuscular dissection (McBurney).—This method isemployed chiefly for the removal of an appendix in an in-terval operation. The incision through the skin and fasciae,. Fig. 65. Trap-door incision. The anterior rectus sheath has been in-cised, and is retracted, exposing the rectus abdominis. made parallel with the direction of the fibres of the obliquuscxternus, exposes, with the aid of retractors, that muscle it-self. After it has been divided, by blunt dissection along thecourse of its fibres, the sharp retractors should be inserted 186 The Surgical Assistant. into it, in order to expose the obliquus internus. After itsdivision, in similar manner, the retractors are shifted to thislayer and placed in a position at right angles to their formerdirection. The transversalis, then exposed and split, is, inturn, to be drawn aside, the retractors now occupying a posi-tion parallel to the line of the body and exposing theperitoneum by a transverse slit. The trap-door dissection (known also as the Kammererincision, etc.).—The outer layer of the rectus sheath is se
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1905
