ABLATION OF TUMORS. 201 



those employed in liumau surgery, and can be comprehended in 

 the four principal processes of excision, ligature, tearing and 

 puncture. They are about equally employed, according to the 

 cu-cumstances and nature of the case, and the discretion of the 

 opei-ator. 



1st. — Excision. 



This mode of ablation can be performed in four ways, with 

 the scissors, the bistoury, the ecraseur or the thermo-cautery. 



(a) With the Scissors. — This is the simplest process, but is 

 apphcable only to tumors of diminutive size, such as warts, con- 

 dyloma, and in general, to growths having a small and narrow 

 peduncle. Curved scissors are generally used. The tumor is 

 raised from the skin and secured with a pair of bull-dog forceps 

 before the scissors are applied. The hemorrhage which may 

 follow is not usually serious, and ordinarily requires no interfer- 

 ence, and when necessary, can be readily controlled by means of 

 cooling aj)pUcations, pressure or cauterization. 



(/>) With the Bistoury. — A\Tien the tumor is comparatively 

 small, with a narrow peduncle, its removal is effected in the same 

 manner as with the scissors, the only change being in the stroke 

 of the instrument. Usually a single stroke of the bistoury is suf- 

 ficient. But if the tumor is of large dimensions and covered by 

 the skin, the operation becomes more complicated and requires 

 more time and care. It is ordinarily divided into three steps, viz. : 

 the incision of the skin, the dissection of the tumor, and its extir- 

 pation. 



The form and size of the incision must of course correspond 

 to those of the tumor, which must be considered in reference 

 to its basis, connections, adhesions and surrounding tissues, as 

 well as the healthy or morbid condition of the teguments. The 

 straight incision is ajiplicable to subcutaneous tumors, free from 

 adhesions or comparatively loose and susceptible of enucleation, 

 while that made through a fold of the skin is better adapted to 

 encysted growths, which it would be dangerous to open. The 

 elliptic incision is used when aj)ortionof the skin is to be removed, 

 because of its being diseased or too thin, and its closing up would 

 be too difficult; or when the extent of the skin exceeds that of 

 the wound it covers. Crucial incisions, or those of the T or Y 

 shape, are indicated when a tumor of large size is to be exposed, 



