OPERATIONS 



907 



OPERATIONS 



r division of its connections on the opposite side, 

 zeanneau's, for naso- pharyngeal tumor : the hard 

 ate is divided in the middle line, from its junction 

 th the soft palate, forward to or beyond the palato- 

 xillary suture ; the section is then carried across at 

 ht angles until it approaches the alveolar process, 

 hen it is turned and carried backward to the soft 

 ate. Dianoux's, for entropion : the formation of a 

 iarv and cutaneous flap ; separation of the underlying 

 uscle from the tarsus, and suture of both flaps to the 

 of the latter. Diday's, for webbed fingers ; 

 o narrow longitudinal flaps are dissected up from 

 e palmar and dorsal aspects of the fingers, and each 

 is then folded round to cover the denuded surface 

 the finger to which it is attached. Didot's, for 

 bbed fingers ; the same as Diday's operation. Dief- 

 bach's (J. F.) : I. Y ox amputation at the hip-joint ; 

 elastic ligature is applied around the limb, a circular 

 ion is made down to the bone, the vessels are se- 

 d and the ligature removed ; a knife is inserted 

 o inches above the greater trochanter and the incis- 

 is carried down the outer aspect of the bone to 

 t the circular incision ; the joint is then disarticu- 

 ed. 2. For blepharoplasty ; a quadrangular flap is 

 cen from the cheek. 3. For chiloplasty ; the diseased 

 rtion of the lower lip is removed by a wedge- 

 aped incision ; the gap is closed by making horizon- 

 incisions on both sides, and then introducing sutures. 

 For cicatricial entropion ; a triangular flap is re- 

 ived and the gap is closed by displacing and trans- 

 anting a large quadrilateral flap and leaving the raw 

 ace to close by granulation. 5* To expose the 

 ole of the upper jaw ; an incision is made through the 

 nter of the lip, around the ala, and up along the side 

 the nose to the inner canthus, and then outward just 

 low the margin of the orbit, as far as _ the malar prom- 

 ience. 6. For the removal of naso-pharyngeal tumors ; 

 incision, beginning at the lower and outer angle of 

 e nostril, is carried along the base of the nose in the 

 labial fold until the ala of that side can be easily 

 ed upward and inward. If necessary the same 

 be done on the opposite side. 7. Osteoplasty, 

 cleft in the hard palate ; the edges are pared and 

 th soft tissues and bone divided on each side, the 

 tached portions being prised toward the middle line. 

 For restoration of the upper lip ; [a) the formation 

 a quadrangular flap, attached below, at the level of 

 e mouth, which is turned horizontally inward to meet 

 similar one on the other side ; this is the reverse 

 Stdillofs operation ; (b) two curved incisions start 

 >m the apex of the partial central defect and are car- 

 round the alae of the nose ; the flaps thus marked 

 t are detached and brought together in the median 

 :. 9. For rhinoplasty; (a) repair of the nose by 

 ing a pyriform flap from the forehead; (b) three 

 ongated flaps are raised from the sunken nose and 

 en re-united with sutures, and made to project for- 

 ard by drawing previously detached portions of the 

 eeks toward the median line. 10. For single hare- 

 a modification of Stokes'' operation in which ad- 

 tional incisions are made skirting the ala nasi, with 

 ie object of securing more tissue. II. For symbleph- 

 aron ; it consists in folding the lid inward and plac- 

 ing the skin against the eyeball. 12. For tenotomy ; 

 division of the belly of the muscle. Dittel's, for en- 

 larged prostate ; enucleation of the lateral lobes of the 

 prostate by an external incision. Dolbeau's, for 

 lithotomy ; a median incision is made into the prostatic 

 urethra, followed by dilatation of the wound by means 

 of metallic dilators ; the stone is then crushed and the 

 debris evacuated. Donegana's, for iridodialysis ; it is 

 >ne by means of a special needle ; the iris is detached 



done b 



II 



and then incised from its circumference toward the 

 center. Dowell's {G.) t for the radical cure of hernia ; 

 plugging of the mouth of the sac with its invaginated 

 fundus and securing the fundus to the crjTOunding tis- 

 sues by sutures tied overa piece of cork. Drausart's : 



1 . For ptosis ; the occipito-frontalis muscle is. brought 

 to act on the lid through the medium of cicatricial bands, 

 bv means of threads, which are allowed to ulcerate 

 their way through the tracks along which they were 

 passed. 2. For retinal detachment ; iridectomy, the re- 

 cumbent position, a pressure-bandage, and subcutane- 

 ous injection of small doses of pilocarpin. Dub- 

 rueil's : I. For amputation of the hand; a single 

 semilunar flap is formed from the dorsal surface of the 

 metacarpal region of the thumb, and when raised, the 

 two ends of its base are joined by a circular incision 

 around the arm at the wrist, followed by disarticulation. 



2 . For amputation of the toes ; disarticulation of the toes 

 en masse at the metatarsophalangeal joints by a more 

 or less circular incision, a U-shaped flap being cut from 

 the inner side of the great toe. Dudley's, for retro- 

 version of the uterus ; the abdomen is opened, and a 

 strip is denuded from the anterior surface of the uterus, 

 and likewise a strip along the inner side of each round 

 ligament, followed by suturing of the three together. 

 Duncan's : 1. For lacerated perineum ; an incision is 

 made in the median line on the posterior vaginal wall 

 as far as the laceration extends. From the lower end 

 of this an incision is made up along the vulval border 

 of the laceration on either side. The flaps thus out- 

 lined are dissected up, and stitched together, and the 

 labia brought together by deep cutaneous sutures. 2. 

 A method of transfusion ; re-infusion of the patient's 

 own blood mixed with a solution of sodium phosphate. 

 Duplay's : 1. For epispadias ; the urethra is formed 

 at the expense of the corpus spongiosum and corpora 

 cavernosa instead of by flaps. 2. For hypospadias ; 

 it is performed in three stages ; (1) straightening of 

 the penis and the formation of a meatus ; ( 2 ) the for- 

 mation of a canal from the meatus to the hypospadiac 

 opening; (3) junction of the old and new canals. 

 Dupuytren's ( G. ) : 1 . Method of performing ampu- 

 tations ; the double-flap method, the skin-incisions 

 being made by cutting from without inward, and the 

 flaps completed by transfixion. 2. For amputation at 

 the shoulder-joint; two rounded flaps are taken from 

 the outer and inner aspects of the arm ; the outer flap 

 is made first by transfixion from behind at a point two 

 inches below the acromion ; the bone is then disarticu- 

 lated and a short inner flap cut from within outward. 



3. For atresia vagina ; combined incision and dilata- 

 tion. 4. For chiloplasty ; excision of the diseased 

 tissue, the wound being allowed to heal by granula- 

 tion. 5. F "or closure of an artificial anus ; compression 

 of the spur with the clamp, followed by a plastic 

 operation on the skin. 6. For division of contracted 

 palmar fascia ; the open method, both skin and fascia 

 being divided by a simple transverse incision. 7. For 

 excision of the elbow. The same as Moreaus operation. 



8. For lithotomy ; the bilateral method. See Lithotomy. 



9. For stricture of the lacrymal duct ; incision of the 

 anterior wall of the sac, and the passage of a fine gold 

 or silver probe through the duct. 10. For suture of 

 the intestine ; the edges of the wound are turned in- 

 ward and the opposed folds of serous membrane 

 brought together by means of an ordinary continuous 

 suture, without involvement of the mucous membrane. 

 II. For wry-neck; tenotomy of the stemo- mastoid 

 muscle. Duval's [M. ) : 1 . For amputation of the 

 leg ; an oblique elliptic incision is made around the 

 limb above the malleoli and the bone divided higher 

 than in Guyon's operation. 2. For ligation of the 



