RESECTION OF BONES. 295 



The manipulations will of course vary, according to the bone 

 which is to be incised. AVhen one of the long bones is to be re- 

 sected in its long axis, either in part or in whole, the periosteum 

 must be kept as nearly intact as possible ; as the jjrinciple regen- 

 erator of the osseous tissue, its removal would necessarily interfere 

 with the cicatrizing process. It must be very careftdly separated 

 from the bone, and isolated, to the whole extent of the segment 

 to be removed. This done, the bone can be readily cut off, with 

 either the chain saw or the plain instrument. The resection of 

 bones in theii' articular extremities seldom occurs in our practice ; 

 it sometimes becomes necessary in diseases of the vertebrae, in fis- 

 tulous withers, and occasionally in caries of the ribs. 



In the first case, that of the diseased vertebrae, the excision is 

 commonly made with the bone forceps and chisels, or even with 

 the gouge. The principal point to observe in these instances is 

 to avoid injury of the ligamentum nuchoe as much as possible, 

 and to save all the periosteum that can be preserved. 



The resection of ribs is accomplished with difiiculty, on account 

 of the proximity of the pleura which lines their internal surface. 

 To avoid woimding this important organ the rib is exposed by a 

 longitudinal or crucial incision, and after isolating the intercostal 

 muscles from their attachments, the pleura can be pushed away 

 from the bone with the blunt end of a scalpel, and with the chain 

 saw introduced carefully between the bone and the pleura, the 

 resection can be accomplished by dividing the bone from within 

 outwards. The hemorrhage which arises from the intercostal 

 artery can be stopped by plugging. The wound is dressed by a 

 protective antiseptic bandage applied round the chest. 



The general indications, after the resection of bones, are to care- 

 fully watch the progress of the wound and watch for the possibility 

 of the formation of fistulous tracts, which may result from the 

 extension of the necrosis, which may not have been entirely re- 

 moved, or may result from the removal of the periosteum. These, 

 however, may often be prevented by so regulating the process of 

 granulation, as to prevent the accumulation of pus in the wounds, 

 and if necessary, by applying caustics or resorting to any other 

 of the means recommended to fulfil the existing indications. 



