OPERATIONS 



914 



OPERATIONS 



of a quadrangular flap from the cheek and nose, followed 

 by the insertion of sutures. 2. F'or cataract-extraction ; 

 the formation of de IFecker's corneal flap ; a broad 

 iridectomy and peripheral opening of the capsule ; the 

 lens is expelled by gentle pressure on the lower part of 

 the cornea. 3. For cleft lobule of the ear ; denudation 

 by transfixion, and cutting out and suturing. 4. For 

 coloboma palpebrce ; a combination of simple union and 

 blepharoplasty. 5- For divergent strabismus ; division 

 of the external rectus ; insertion of a double suture 

 through the inner margin of the cornea and through 

 the inner canthus. 6. For evisceration ; a modification 

 of Critchetf s method, in which conjunctival instead of 

 scleral sutures are used. 7. F 'or pterygium ; a modi- 

 fication of Desmarre' s operation ; the corneal portion 

 is excised, and the remainder is divided into two parts, 

 one being transplanted under the conjunctiva above 

 the wound and the other below. 8. For staphyloma ; 

 a modification of Critchetf s method of closing the 

 wound after operation upon the staphyloma. Critchett 

 inserted stitches in the sclera, Knapp only in the 

 conjunctiva. 9. For symblepharon ; a modification 

 of leale ' s operation. Knox's, for excision of the 

 tongue; a vertical incision is made through the center 

 of the lower lip, and the inferior maxilla is ex- 

 posed and sawn through at the symphysis ; the 

 tongue is then dealt with as the case demands. 

 Kocher's: 1. For excision of the ankle-joint ; the 

 incision is made beneath the external malleolus, and is 

 followed by division of the peroneal tendons after 

 being secured with threads, and. opening of the joint 

 with removal of the diseased parts ; the foot is replaced 

 and the tendons sutured. 2. For excision of the 

 thyroid gland ; an incision is made in the median line 

 from the sternal notch to the upper limit of the bron- 

 chocele ; from this point two lateral incisions are made 

 upward and outward to a point a little below the angle 

 of the jaw. 3. For excision of the tongue ; preliminary 

 tracheotomy and packing of the pharynx with sponges ; 

 the incision begins below the tip of the ear, extends 

 along the anterior border of the sterno-mastoid muscle 

 to about its middle, then forward to the body of the 

 hyoid bone, then upward along the anterior belly of 

 the digastric muscle to the symphysis menti ; the 

 tongue is then removed by the galvano-cautery or 

 scissors through the incision. This operation was 

 devised to avoid pneumonia and septicemia. 4. For 

 varicocele ; ligation of the veins at two points, and 

 subcutaneous division. Koeberle's : I. A method of 

 performing oophorectomy ; the pedicle is grooved with 

 a specially-devised wire constrictor prior to liga- 

 tion. 2. For retroflexion uteri ; abdominal fixation. 

 Kolomnin's, for hip-joint disease ; ignipuncture or 

 cauterization of the diseased tissue. Konig's : 1 . For 

 nephrectomy ; an incision is made vertically down- 

 ward along the outer border of the erector spinre muscle 

 to just above the iliac crest, then curving anteriorly, 

 and extending nearly, or quite, to the umbilicus. 2. For 

 single hare-lip; both margins are pared, and two 

 small prolabial flaps are formed by horizontal incisions 

 parallel to the lip-margin. Kraske's : I. For car- 

 cinoma of the rectum ; resection of the coccyx and of 

 a portion of the sacrum to give access to the rectum 

 high up. 2. For extirpation of the uterus ; the opera- 

 tion is made through the same sacral opening as in 

 operating for carcinoma of the rectum. 3. For melo- 

 plastv ; a flap is taken from the immediate neighbor- 

 hood, and union follows, even if the pedicle consists 

 of subcutaneous tissue only. Krimer's, for urino- 

 plasty ; muco-periosteal flaps are dissected up on either 

 side of the cleft, then reversed from without inward, 

 and united in the middle line by sutures. Kuckler's ; 



I. For cataract-extraction; the incision passes 

 through the center of the cornea. 2. For splenec- 

 tomy; the incision is made through the linea semilu- 

 naris. Kuhnt's : I. For canthop/asty ; a flap of 

 skin is cut from the upper or lower lid, and turned 

 into a wound made at the outer canthus. 2. For 

 ectropion; a modification of Antyllus's operation. 

 3. For symblepharon ; the use of skin-flaps grafted 

 upon the surface, or pedicellate flaps which arc thrust 

 in between the eyeball and eyelid through fenestra cut 

 through the latter. Kiister's : I. For performing 

 gastrostomy ; the parietal incision is made in the linea 

 alba. 2. For mastoid and middle-ear disease: it con- 

 sists in making an opening in the posterior wall of the 

 auditory canal as far away from the memhrana tvmpani 

 as possible in cases in which some of the membrana 

 and the ossicles are still retained; if the drum-cavity 

 is filled with granulations the incision should be carried 

 through the bone into the drum-cavity, and the morbid 

 material removed with a spoon. Kiister-Dolbeau's, 

 for vesical exploration ; paraprostatic section of the ure- 

 thra and subsequent dilatation to allow of the introduc- 

 tion of the fingers. Labbe's, for gastrotomy ; the pari- 

 etal incision is made parallel to the left costal margin. 

 Lacauchie's, for amputation at the hip-joint ; the 

 same as EsmarcK ' s amputation. Lafage's, 

 tration ; by an elliptic incision in the scrotum. La- 

 forest' s, for stricture of the laerymal duct ; the in- 

 jection of an astringent solution through an S shaped 

 hollow probe. Lallemand's, (or circumcision ; dorsal 

 transfixion, fojlowed by excision of the two lateral 

 flaps. Landolt's, for blepharoplasty ; a portion of the 

 upper lid is taken to replace a lost lower lid. Lang- 

 enbeck's : I. A method of performing amputations; 

 the making of musculo-tegumentary flaps by cut- 

 ting from without inward. 2. For cholecystectomy ; the 

 entire gall-bladder is removed, after division of the 

 cystic duct, between two ligatures. 3. For double hare- 

 lip ; the edges of the prominent tubercle and of the 1 

 maxilla are pared, and, after replacement into position, I 

 the parts are transfixed with hare-lip pins. 4. For 

 duodenostomy ; the bowel is attached to the wound in 

 the parietes and opened at a later stage of the oper- 

 ation. 5* For ectropion; the same as v. Amnion s\ 

 operation. 6. ¥ ox excision of the ankle: a modifica- 

 tion of Jlforeau's operation, in which the outer incision 

 follows the anterior portion of the fibula, curves around - 

 and below the malleolus and ascends about one inch 

 along its posterior border. 7. For excision of t> 

 elbow ; a longitudinal posterior incision is mad 

 the inner side of the olecranon. 8. For ex> 

 the hip ; an external incision is made in the long a.\b 

 of the limb over the outer surface of tl. 

 trochanter. 9. For excision of the knee ; a vertical j 

 incision is made on the antero-internal aspect of the 

 joint. 10. For excision of the shoulder; 

 vertical incision is made, having for its start ii 

 the acromio-clavicular joint. II. For excision nf t 

 upper jaw ; a transverse curved incision, with 

 vexity downward, is carried from the junction of the 

 nasal cartilage with the nasal bone to the middle of UK 

 malar bone. 12. For excision of the wrist ; the same a- 

 BceekeP s operation. 13. For iridodialysis ; i; 

 is united with detachment ; the detached flap of t 

 iris is drawn into the corneal wound, where it 

 retained by adhesions. 14. For completely lacerw 

 perineum ; the edge of the recto-vaginal septum 1 

 denuded and then split for some distance ; a flap is 1 1 

 out of the vaginal side, and, after closure <>l the 1 

 turn, is stitched forward over the new perineum 1 

 vaginal sutures; the external sutures are placed fr 

 before backward. 15. For the removal of 



