. Manual of operative surgery. removal of deformity. Expose the thyroid through the usual collar incision. If both lobes are en- 264 goitre; bronchocele; struma larged, dislocate them both. Determine how much glandular tissue must beremoved from each side to ensure symmetry and cure. Divide the isthmus, ifpossible, between clamps. Free the isthmus and lobe on one side from theirtracheal attachments anteriorly and laterally sufficiently to relieve all pressureand to permit of proper suturing after resection. Do the same to the other halfof the gland. Apply a series of Ochsner forceps around the
. Manual of operative surgery. removal of deformity. Expose the thyroid through the usual collar incision. If both lobes are en- 264 goitre; bronchocele; struma larged, dislocate them both. Determine how much glandular tissue must beremoved from each side to ensure symmetry and cure. Divide the isthmus, ifpossible, between clamps. Free the isthmus and lobe on one side from theirtracheal attachments anteriorly and laterally sufficiently to relieve all pressureand to permit of proper suturing after resection. Do the same to the other halfof the gland. Apply a series of Ochsner forceps around the area to be resected: one forcepsabout I inch from the upper pole, one near the lower pole, three or four laterallyon the larger vessels in the capsule, and two or three on the tracheal side. Theseforceps mark the limits of the resection and enable one to control bleeding bytraction on them along with support of the lobe from behind with the an incision through the capsule around the lobe just within the circle of. Isihmus Trachea Thuroidea imaVein. Fig. 396.—Resection-enucleation. forceps (Fig. 395). Wedge out the interior of the gland. Multiple adenomasand masses of colloid are easily enucleated by the finger. The superior and in-ferior poles and a layer of gland tissue covering the posterior capsule are leftintact. Bring the walls of the wounded gland into contact and fix them to-gether by a continuous mattress suture of catgut introduced behind the row ofOchsner forceps. Remove the forceps. Introduce sufficient stitches to com-plete the closure of the glandular wound and to assure hemostasis. Method F.—Resection-enucleation (Kocher).—This method is very like thatof V. Mikulicz, but avoids leaving large ligated masses near the location ofthe recurrent nerve. Kocher has noticed that when many large pedicles areligated near the nerve the necessary contraction of the tissues by the ligatureoften causes injury to it. The Operation.—Step i.—E
Size: 1779px × 1404px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1920, bookpublisherphila, bookyear1921
