. Manual of operative surgery. poneurosisskirting the growth anteriorly and laterally. Make the cut inch by inch,using compression on each side of the cut against the bone until the vessels aresecured by forceps and ligatures. Isolate and doubly ligate the main vessels 4 SCALP before dividing them. This incision outlines a horseshoe-shaped flap havingits base at the occiput. Step 2.—Reflect the flap from the cranium. This step requires the use ofmany hemostats and ligatures because of the free anastomosis with the deepvessels. Step 3.—As in Bryants operation, place gauze between the flap and t
. Manual of operative surgery. poneurosisskirting the growth anteriorly and laterally. Make the cut inch by inch,using compression on each side of the cut against the bone until the vessels aresecured by forceps and ligatures. Isolate and doubly ligate the main vessels 4 SCALP before dividing them. This incision outlines a horseshoe-shaped flap havingits base at the occiput. Step 2.—Reflect the flap from the cranium. This step requires the use ofmany hemostats and ligatures because of the free anastomosis with the deepvessels. Step 3.—As in Bryants operation, place gauze between the flap and the the flap over the gauze. Apply dressings and bandage. Step 4.—After three or four days remove the dressings and excise the tumorfrom the under surface of the flap. Thrombosis of the vessels in the tumor,and loosening of the surrounding connective tissue due to the edema, make theexcision of the growth easier than it would have been at the first sitting. Step 5.—Replace the flap. Suture. Dress the V? ifpMH p -?^f^H 1 i ^ii \ Fig. 5. Fio. 0. Figs. 5 and 6.—Cirsoid aneurysm. {Clalrmonl.) (D) Excision.^—It is very easy to excise small nevi and to close the woundwith sutures. When large nevi are being excised hemorrhage during the excisionmay be avoided by tying an elastic constrictor tightly round the head as intrephining or by having a rubber-covered ring (ring pessary) pressed firmlyagainst the scalp surrounding the nevus. The operation consists in excising thedisease by cutting through healthy tissue, in securing hemostasis and in closingthe wound either directly or by some plastic procedure. The freezing treatment of nevi threatens to displace all other methods. Liquid Air.—First get the liquid air. Make a very firm pad of cotton on theend of a stick. Dip the pad in liquid air. Shake off any loose drop of the the charged pad with moderate firmness on to the nevus for a few the process on every part of the lesion.
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