. Manual of operative surgery. iple is not carriedinto practice is shown by the various devices used to obtain siphonage of thepus. A glance at Figs. 423, 424 and 425 will show why an opening in theposterior axillary line at the level of the sixth rib or even one in the scapularline, cannot give proper drainage whether the patient is recumbent or seated,whereas an opening at the costal angle (Fig. 425) must permit sufficientemptying of the vertebrocostal gutter in the recumbent posture. The low point, , the proper site for pleural drainage, is in the costo-vertebral gutter at the reflexion
. Manual of operative surgery. iple is not carriedinto practice is shown by the various devices used to obtain siphonage of thepus. A glance at Figs. 423, 424 and 425 will show why an opening in theposterior axillary line at the level of the sixth rib or even one in the scapularline, cannot give proper drainage whether the patient is recumbent or seated,whereas an opening at the costal angle (Fig. 425) must permit sufficientemptying of the vertebrocostal gutter in the recumbent posture. The low point, , the proper site for pleural drainage, is in the costo-vertebral gutter at the reflexion of the pleura from the chest wall on to the dia-phragm. Normally the pleural reflexion is very low in the chest (about theeleventh intercostal space) but in disease the costo-diaphragmatic cul-de-sac ClIEVRIKk S rUINCIPLES 303 is pushed upwards to a varying degree (Figs. 426 and 427) and in each casemust be found by exploration during the operation. Step I.—Just external to the mass of the erector spinae muscles explore for. Fig. 423.—Segment of the 6th rib has been excised in posterior axillary line. Retentionof fluid when patient is recumbent. {Chevncr, La Pr. Med., Jan. 9, 1919.) pus with an aspirating needle. This is best done under guidance of the fluoro-scope as this permits the puncture being made if not at the exact inferior limitof the effusion at least in its lower zone.
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