OPERATIONS 



908 



OPERATIONS 



common iliac artery ; an incision about five inches in 

 length is commenced one-and-one-quarter inches to 

 the outer side of the spine of the pubes, just above 

 Poupart's ligament ; after running parallel with this 

 ligament for one-and-a-half inches, the incision curves 

 sharply upward and is directed toward a point one- 

 and-one-quarter inches to the outer side of the um- 

 bilicus. Bly's, for otitis media suppurativa chronica ; 

 the grafting of small pieces of skin on the granulat- 

 ing surfaces. Emmet's ( T. A. ) : I. Colporrhaphy ; 

 a modification of Sims' colporrhaphy ; ' the sutural ap- 

 proximation of three equidistant, transverse, infracer- 

 vical denuded spots on the anterior wall of the vagina, 

 and the apposition of the opposing edges of the folds 

 thus formed after abrasion. 2. For cystocele and ure- 

 throcele ; the buttonhole operation ; the removal of a 

 small circular portion of tissue, opening the bladder or 

 urethra, to provide for drainage ; this is afterward 

 closed by operation. 3. For lacerated perineum ; the 

 crest of the rectocele and the two lower caruncles are 

 drawn together by tenacula, and the tissue thus folded 

 together is denuded as far into the sulci as the folds 

 extend. The V-shaped stitches are passed from the 

 center toward the circumference in the sulci, and the 

 perineum is closed by two or three superficial sutures. 

 4. For ovariotomy ; the pedicle is ligated with silver 

 wire. 5- V or procidentia uteri ; freshening of the an- 

 terior vaginal wall in the middle line and on either 

 side. The two lateral denudations together should 

 correspond in size and shape to the one in the median 

 line. The lateral fresh surfaces are then folded on the 

 central one and stitched. See Emmets colporrhaphy. 

 6. For trachelorrhaphy ; the edges of the rent are 

 pared and united by sutures. Erichsen's : 1. For 

 nevus ; ligation of the base with a double ligature 

 which is tied in segments. 2. For varicocele ; after 

 separation . of the vas deferens from the veins, an in- 

 cision one-half inch long is made on the anterior and 

 posterior aspects of the scrotum ; the veins are then 

 included in a loop of wire without implicating the 

 scrotum. Esmarch's : 1. For amputation through 

 the foot; a modification of Pirogoff' 's amputation ; 

 two incisions are made, one across the sole and the 

 other across the dorsum of the foot. 2. For amputa- 

 tion at the hip-joint ; the soft parts of the thigh are 

 divided to the bone by a single sweep of the knife 

 five inches below the tip of the trochanter ; the bone is 

 then sawn across and a second incision is made to 

 join the first from a point two inches above the 

 trochanter, when the bone is shelled out. 3. For 

 ankylosis of the lower jaw; an incision about two 

 inches long is made along the lower border of the jaw, 

 and a wedge-shaped piece of bone is removed from 

 the horizontal portion. Estlander's: 1. Thoraco- 

 plasty for empyema ; resection of several ribs to allow 

 the chest-wall to come in contact with the lung. 2. 

 For restoration of the loiver lip ; a triangular flap is so 

 fashioned from the upper lip that its base contains the 

 coronary artery, while its apex is situated on the cheek ; 

 this flap is turned downward, with its apex occupying 

 the lower angle of defect. D'Etiolles' (Leroy) : 

 I . For the radical cure of inguinal hernia ; a scro- 

 tal fold is passed in the inguinal canal and held by 

 means of special forceps. 2. F or iridectomy ; removal 

 of a portion of the iris by an instrument constructed 

 like a tonsillotome. Everbusch's, for ptosis; it 

 consists in shortening the tendinous attachment of 

 the levator palpebrae to the tarsus. A horizontal in- 

 cision is made in the center of the lid ; threads armed 

 at each end are used, and, after transfixing the tendon 

 in the wound, the needles are brought out at the free 

 margin of the lid, and the silk tied. Farabeuf's 



(Z. H.~) : I. ¥ ox amputation at the elbozv-joint ; (a) an 

 elliptic amputation with the highest point of the ellipse 

 over the prominence of the olecranon ; (b) a modi- 

 fication of Guerin's operation in which the single 

 external flap is made longer. 2. For amputation of 

 the fool. See subastragaloid amputatioti of the same 

 surgeon, with which this is identical in all essential 

 points. 3. For amputation of the forefinger ; dis- 

 articulation at the metacarpophalangeal joint by an 

 external palmar flap. 4. P or amputation of the great 

 toe ; disarticulation at the metatarsophalangeal joint 

 by an internal plantar flap. 5- F° r amputation above 

 the knee-joint ; a modification of Carderi s amputation 

 in which two flaps are formed, the anterior being the 

 longer one. 6. P'or amputation of the leg ; it is done 

 at the ' ' place of election " by a large external flap, being 

 a modification of Sedillofs operation in which the an- 

 terior tibial artery is preserved in the entire length of 

 the flap. 7. For amputation of the thigh ; a modifica- 

 tion of Spencer 's amputation in which slightly different 

 flaps are used. 8. Por amputation of the thumb: 

 disarticulation at the metacarpo-phalangeal joint by an 

 oblique palmar flap. 9. For subastragaloid amputa- 

 tion ; by a large internal and plantar flap. 10. Por 

 otherwise impossible labor. See Galbiati's Operation. 

 Fenger's (C.) : I. For gastrostomy; a parietal in- 

 cision is made parallel with and near to the left 

 costal margin. 2. For traumatic cerebral abscess: 

 exploratory puncture and aspiration, in conjunction 

 with trephining. Fenwick's, for excision of the 

 knee ; both femur and tibia are sawn in a curved line 

 so as to make them fit together more accurately. 

 Fergusson's (Sir W.): I. For amputation through 

 the foot; the same as Pirogoff s operation, except 

 that the malleoli are not interfered with, unless dis- 

 eased, the retained portion of os calcis being thrust 

 up between them. 2. For amputation at the hip- 

 joint ; a modification of Liston's amputation in which 

 the posterior flap is made longer than the anterior. 

 3. ¥ or division of the levator palati muscle ; a triang- 

 ular-bladed knife, set at right angles, is introduced be- 

 hind the velum and the muscle divided close to its 

 origin. 4. For double hare-lip ; removal of the pre- 

 maxillary bone. 5. For excision of the upper jaw; 

 the same naso-labial incision is made as in Liston's 

 operation, a second cut being made from the angle of 

 the mouth to the malar bone, and, if needed, a third 

 at right angles to the outer extremity of the buccal 

 wound. 6. Y or lithotomy ; lateral lithotomy with the 

 curved staff. 7. Osteoplasty for a cleft in the hard 

 palate ; the same as DieffenbacK 1 s operation. Fisch- 

 er's, for stricture of the lacrymal duct; the same as 

 Schmalz's operation, except that a loop of twilled 

 silk is used on the end of a catgut string. Flajani's, 

 for iridodialysis ; the same as Himly's operation 

 Flap-operation: I. A method of amputation; the 

 formation of definite flaps, embracing the skin only, or 

 all the soft parts. 2. For cataract-extraction ; a 

 curved section of the cornea of sufficient extent for the 

 removal of large, hard cataracts. 3. For cicatricial 

 entropion. See Fricke's and Dieffenbach' s operat 

 Flap-splitting. See Tait's Operation. Flarer's, 

 for trichiasis and cicatricial entropion ; the lid is split 

 into two portions as far back as the ends of the hair 

 bulbs of the cilia. The anterior flap, containing the 

 bulbs, is then cut away -by incision through the skin 

 from above. Forbes' (.S". F.), for amputation ti- 

 the foot ; a modification of Choparfs operation, th 

 three cuneiform bones being disarticulated frorfl th 

 scaphoid and the cuboid bone sawn through in ih 

 same line. Forbes' ( IV. S.), the division of th 

 cessory tendons of the extensor communis digitorwn 



