. Medical and surgical therapy . e procedurepointed out above, but in this case the basal haemo-static suture can be dispensed with. The real objectof this suture is to allow of the removal of all theforceps from the edge of the flap when it is not desiredto loosen it from the surface of the skull which itcovers, because these forceps would be very muchin the way when the bone-flap was cut. But in thepresent case the flap is turned back away from thefield of operation, so that the forceps fixed to its edgesare not in the way, and it is sufficient to removethe flap and forceps from the field of
. Medical and surgical therapy . e procedurepointed out above, but in this case the basal haemo-static suture can be dispensed with. The real objectof this suture is to allow of the removal of all theforceps from the edge of the flap when it is not desiredto loosen it from the surface of the skull which itcovers, because these forceps would be very muchin the way when the bone-flap was cut. But in thepresent case the flap is turned back away from thefield of operation, so that the forceps fixed to its edgesare not in the way, and it is sufficient to removethe flap and forceps from the field of operation forthem to give no more trouble (fig. 49). The dimensions of the cutaneous flap should bea good de^l larger than those of the wound. Theosseous lesions are frequently more exiensive thanthe cutaneous ones, and it is desirable that the former 828 WOiXDS OF THE SKULL should be completely visible when the flap has beenreflected. In these tangential wounds the operator findshimself confronted by a more or less deep furrow. Fig. 49.—The flap being turned back, away from the field of operation,the forceps fixed to its edges are out of the way, and it is sufficientto cover over the flap and forceps for them to give no more trouble. in the brain substance itself. Some splinters maypenetrate the brain, but, generally, they are superficial,and are not deep in the interior, as is so often thecase in apparently less serious wounds produced bymissiles striking the skull direct. The edge of the osseous furrow must be trimmedwith the gouge-forceps and healthy dura mater ex- TRUE CRANIECTOMY a? 9 posed; but in doing this, as in all other surgicaloperations, I am of opinion that an effort should bemade to proceed from the sound to the damagedarea, and that it is often dangerous to pass the jawsof the gouge-forceps below the edge of the bone intothe damaged region, where there is so much alterationin the structures that itis impossible to get onesbearings clearly. Thereis a risk of
Size: 1600px × 1561px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
