. Operative surgery, for students and practitioners . dons for a greater distance below the anatomical neck. The operation as described above differs from Langenbecks onlyas regards the incision. The incision of Langenbeck commencesabove at the acromion process, and is therefore more external; pass- 543 UPPER EXTREMITY. ing through the body of the deltoid, it divides the circumflex nerve,and is therefore likely to be followed by impairment of the functionof the deltoid. Tendon Suture.—Tendons may be found divided as a complicationof a wound, or they may be accidentally cut by the surgeon durin
. Operative surgery, for students and practitioners . dons for a greater distance below the anatomical neck. The operation as described above differs from Langenbecks onlyas regards the incision. The incision of Langenbeck commencesabove at the acromion process, and is therefore more external; pass- 543 UPPER EXTREMITY. ing through the body of the deltoid, it divides the circumflex nerve,and is therefore likely to be followed by impairment of the functionof the deltoid. Tendon Suture.—Tendons may be found divided as a complicationof a wound, or they may be accidentally cut by the surgeon during thecourse of an operation about a joint; one or several may be proximal portion of the tendon, that which is joined to the muscle,may be separated a considerable distance from the distal portion, owingto the contraction of the muscle, and at times considerable search maybe necessary to secure it, or it may be necessary to lay the sheath of thetendon open for this purpose. The ends should be approximated and joined by a catgut suture,. Fig. 236.—Divided Tendon Reunited by a Single Mattress Suture. one passing through the tendon proper being probably the most satis-factory. If the flexor tendons are divided, in order to coapt the endsand retain them in position with the minimum degree of tension, thejoint must be placed in a position of flexion, and the reverse when theextensor tendons are severed. Asepsis is a necessary condition tohealing; if the parts are infected, an effort should be made to renderthem sterile, and under these circumstances drainage in addition isprobably advisable. Nerve Suture.—A nerve-trunk may be severed, either accidentallyby the surgeon during the course of an operation or the condition maybe encountered as a complication of an accidental wound. The ends should be approximated and united with one or more AMPUTATIONS, RESECTIONS, ETC. 549 plain catgut sutures, which may be passed through the body of thenerve proper. The union may be e
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