CRUKAL MYOTOMY. 311 



Generally the dislocation is unilateral, but in other cases it may 

 occur in both legs. This last condition is always of a serious 

 natui-e, and seldom responsive to treatment. The displacement of 

 the biceps femoris seldom recovers naturally, although where in- 

 comi^lete and intermittent, it may be benefitted by long rest, or 

 when, as we have before remarked, it is due to the excessive lean- 

 ness of the patient, in which case a hberal fattening diet will prove 

 the best remedy, by removing the cause of its appearance. Local, 

 external topical treatment by blisters, plasters, setons, etc., are of 

 no avail. The section of the muscle or the operation of crural 

 myotomy, is the indication. The modus operandi is not uniform, 

 although the final object is the same in all. 



Oiu- opinion in respect to the best way of operating is in favor 

 of that by the subcutaneous section. This is performed below the 

 trochanter, and yet as near to it as possible, where the excessive 

 tension of the hooked muscle can readily be felt. This consists 

 simj)ly in making a small incision through the skin, by which to 

 introduce a blunt bistoury, which is inserted under the muscle, 

 with a director or a finger for a guide, and when at a proper depth 

 tiu'ned to bring the sharp edge towards the aponeurosis, and cutting 

 it from within outward, carefully avoiding the section of the skin. 



Fig. 327.— Gouze's Bistoury. 



The bistoury invented by N. Gouze answers the purpose very well. 

 There is no after-treatment required beyond the ordinary care re- 

 quired for all wounds. 



Simple as the operation of crural myotomy is, some compHca- 

 tions may accompany it. 



Hemorrhage is not uncommon, usually subsiding without inter- 

 ference, but sometimes requiring the application of hemostatics. 



Inter-Muscular Abscesses. — Diffused Suppuration. — These are 

 the result of improper manipulations during the operation, such 

 as lacerations of the cellular tissue by introducing the fingers too 

 frequently into the wound, or dividing the muscle in several places. 



Ganyrene. — Though but rarely met with, this should be re- 

 membered among the possible contingencies. It may occur as the 



