. Annals of surgery . ve that ether is the best ana:stheticfor these cases. The removal of the external table adds exceedingly to thedegree of shock, if the patient is conscious or semi-conscious. True, one mayadd sufficient narcotic to produce unconsciousness, but morjjhine and scopo-lamine with or without apomorphia masks shock. I have had two deaths follow 448 MAXAGEMKNT OF INJURIES TO THE CRANIUM prolonged operations on the head (not for defect) which would have beendone in two stages had not the patients real condition been masked by thenarcotic, the full pulse of narcosis giving a false
. Annals of surgery . ve that ether is the best ana:stheticfor these cases. The removal of the external table adds exceedingly to thedegree of shock, if the patient is conscious or semi-conscious. True, one mayadd sufficient narcotic to produce unconsciousness, but morjjhine and scopo-lamine with or without apomorphia masks shock. I have had two deaths follow 448 MAXAGEMKNT OF INJURIES TO THE CRANIUM prolonged operations on the head (not for defect) which would have beendone in two stages had not the patients real condition been masked by thenarcotic, the full pulse of narcosis giving a false sense of security. In conteni])lating the incision, the main points to be considered are: 1. A flap large enough to include the delect and the area of the skullfrom which the graft is to lie removed. 2. Separation of the flap, including the without opening the dura.(This presupposes, of that there is no intracranial complication.) The large flap makes the separation of the scar over the defect much. Fic. Jc—Case Vin. Prii easier; if the scar is unsightly, or there is any ([uestiun regarding its can be remove<l just before the fla]) is sutured back in ])osition. I know ofone overseas case in which death occurred from ojjening tiie dura when thescar-tissue harbored an old infection that became active, resulting in encepha-litis of quick termination. Had the two ])rincii)les been adhered to. theinfection, in all probability, would have resulted only in a local re-operated on such a case. An alien bone graft had lieen inserted, a localmeningitis developed in three days at which time the graft was removed. Thewound healed in two weeks; subsequent ojieration for defect was refused. Tcchnic.—Using a sharp knife, the jiericranium is divided about i the edge of the defect and reflected inward, the dura is then separatedfrom the inner table, using a blunt dural sejarator; the edge of the defect2» 4 4!. JOHN O. BOWER is roughei
Size: 1799px × 1389px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1800, bookdecade1880, booksubjectsurgery, bookyear1885
