. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. onlywhen advancing or withdrawing the needle. Other tumors of this region can be removed in the same is also quite a simple matter to ligate and divide the upper end of thelong saphenous vein for varicosities of the leg, as in the Trendelenburgoperation, or the entire vein can be removed by a progressive anes-thesia extending from above downward. TH
. Local and regional anesthesia : with chapters on spinal, epidural, paravertebral, and parasacral analgesia, and on other applications of local and regional anesthesia to the surgery of the eye, ear, nose and throat, and to dental practice. onlywhen advancing or withdrawing the needle. Other tumors of this region can be removed in the same is also quite a simple matter to ligate and divide the upper end of thelong saphenous vein for varicosities of the leg, as in the Trendelenburgoperation, or the entire vein can be removed by a progressive anes-thesia extending from above downward. THE UPPER AND LOWER EXTREMITIES 249 The removal of skin-grafts is quite easily performed from theantero-extemal aspect of the thigh, the usually selected site, eitherby direct intradermal infiltration of the entire area, from which thegrafts are to be removed (this intradermal edematization of the skingreatly facilitates their removal without apparently affecting thevitality of the grafts), or by a paraneural injection of the externalcutaneous nerve, where it emerges from beneath Pouparts ligamentclose to the anterior superior spine, as first practiced by Dr. Young ofJohns Hopkins. For this injection the needle is best entered from the. Fig. 49.—Shows method of infiltrating base of bubo area by passing needle obliquely down-ward and inward after embracing area within circle of cutaneous anesthesia. outer side and penetrated to a sufficient depth to reach beneath thefascia lata, under which it is advanced, depositing 2 drams of about per cent, solution of novocain in the recognized position of thenerve. Anesthesia should set in after a few minutes, and be suffi-ciently extensive to allow of a fairly liberal removal of tissue. The removal of varicose veins of the leg need no special descrip-tion, as it is best done through infiltration. Any of the acceptedprocedures may be easily carried out by local anesthesia (exceptstripping of the vein, which will be difficult by this me
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