Operative surgery . t elevators and the fingeras far as could be reached. 4. The ordinary amputation-saw was then applied to the bone in theline of the vertical incision in the periosteum, the soft parts in the neck andthose behind the sternum being protected by flat metal strips. The sawwas held with its point turned toward the neck and its handle toward theensiform cartilage. It should cut most deeply above, and entirely dividethe manubrium at its upper border, the cut being more shallow below, andonly grooving the bone at its lower end. This obliquity of the cut necessi-tates the long skin
Operative surgery . t elevators and the fingeras far as could be reached. 4. The ordinary amputation-saw was then applied to the bone in theline of the vertical incision in the periosteum, the soft parts in the neck andthose behind the sternum being protected by flat metal strips. The sawwas held with its point turned toward the neck and its handle toward theensiform cartilage. It should cut most deeply above, and entirely dividethe manubrium at its upper border, the cut being more shallow below, andonly grooving the bone at its lower end. This obliquity of the cut necessi-tates the long skin incision which has been described. 5. A stout chisel was then applied in the saw-cut at the superior bor-der of the manubrium, and the thin layer of undivided bone on the pos-terior surface was made to give way as the wedge action of the chisel forcesthe two halves apart. 6. The skin was well retracted, a transverse incision made in the peri- * Annals of Surgery, vol. xxxiv, Oct., 1901. THE LIGATURE OF ARTERIES. 165. ^ osteum across the face of the bone at the lower level of the first intercostalspace, and the chisel was applied in this line, directed oblicj[uely outwardfrom the middle line oneach side, so as to divide \ each half of the sternum V in two. The instrument should not be allowed tocut entirely through thebone at the outer borderfor fear of injury to thepleura or internal mam-mary artery. Both lie alittle distance from thebone (Fig. 211), so thatthe danger of woundingthem is not great. 7. Strong retractorswere then inserted in themedian saw-cut, and witha little force the two halves Fig. 211.—The upper end of sternum divided and re- . tractea, exposing deep muscles and periosteum, also were suthciently separated trachea through incision between muscles. to allow access to the periosteum, which was carefully incised with the point of the knife,beginning above, where the danger of damage to the subjacent parts is least. As the periosteum was di-\ vided the halves of
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