Operative surgery, for students and practitioners . he upper, trans-verse, incision that was made along the line of this rib, Avith theperiosteum elevator. As already mentioned, it may not be necessaryto resect the cartilages higher than the fourth. The chondroplasticflap which is thus marked out consists of the fifth, fourth, and thirdcostal cartilages—the sixth has been resected—and the correspondingintercostal muscles, integument, etc. According as the flap is lifted,the soft parts, pleura and triangularis sterni muscle, are cautiously 312 THORAX. peeled away from its under surface and the
Operative surgery, for students and practitioners . he upper, trans-verse, incision that was made along the line of this rib, Avith theperiosteum elevator. As already mentioned, it may not be necessaryto resect the cartilages higher than the fourth. The chondroplasticflap which is thus marked out consists of the fifth, fourth, and thirdcostal cartilages—the sixth has been resected—and the correspondingintercostal muscles, integument, etc. According as the flap is lifted,the soft parts, pleura and triangularis sterni muscle, are cautiously 312 THORAX. peeled away from its under surface and the flap is finally forcibly bentalong its outer border, base^, breaking the ribs at their chondrocostaljunction so that the flap may be reflected and turned down flat upon thechest wall. After the flap has been thus reflected and the pericardialsac exposed and incised, free access may be had to the heart from itsbase to its apex. The pleura may already have been punctured or itmay be torn during the reflection of the flap with a resulting pneumo-. Fig. 151.—Posterior Aspect of Sternum and Ribs; Triangularis Sterni Muscle;Internal Mammary Artery and Vein. thorax. The edges of a small opening in the pleura may be caughtwith the artery forceps or the opening may be covered over with agauze wipe to prevent the entrance and exit of air, A large rent inthe pleura with collapse of the lung may be disregarded until the heartwound has been sutured. It may be necessary occasionally to gain still more room. Forthis purpose an osteoplastic flap may be taken from the sternum andturned over toward the right side. The soft parts, fascia and pleura. OPERATIONS UPON THE HEART. 313 are detached from the under surface of the sternum and the sternumthen cut across above and below, with the bone-forceps. The osteo-plastic flap is bent over toward the right side, fracturing the ribs andmaking a hinge at the right chondrosternal border. The pericardial sac is freely opened and blood and clots clea
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Keywords: ., bookauthormcgrathj, bookcentury1900, bookdecade1910, bookyear1913
