OPERATIONS 



916 



OPERATIONS 



putation at the hip-joint ; lateral flaps about four 

 inches long are made by transfixion, the outer one being 

 cut first. 4. For amputation at the shoulder-joint ; 

 external and internal flaps are made by transfixion ; 

 in operating on the left shoulder the knife is entered 

 near the posterior fold of the axilla, and after passing 

 close to the outer aspect of the joint, is made to 

 emerge between the coracoid process and the clavicle ; 

 on the right side the direction of the transfixion is 

 reversed. 5. For excision of the hip ; it is done by 

 raising the flap from over the great trochanter. 

 Lister's (Sir Joseph) : 1 . A method of performing 

 amputations ; by double rectangular flaps, the differ- 

 ence in length not being so great as in Teale' 1 s oper- 

 ation ; the angles of the flaps are rounded off, the 

 posterior one consisting of skin and fascia only. 2. For 

 amputation at the hip-joint; disarticulation through an 

 external racket incision ; after Ravaton ' s and Fur- 

 neaux Jordan's amputations. 3. Y or amputation above 

 the knee ; a modification of Carden's amputation, in 

 which a short posterior skin-flap is formed. 4. A 

 method of button suture ; oval perforated discs of lead 

 are used which are threaded on the ends of wire. 5- For 

 excision of the zvrist ; the open method, by two 

 dorsal incisions, with division of the extensors of the 

 carous. 6. For ununited fractures of short bones ; the 

 fragments are wired together. Liston's : 1. A 

 method of performing amputations ; & combination 

 of the double-flap and circular operations, by first 

 dissecting up two semi-oval flaps to serve as covers for 

 the flat-faced stump. 2. For amputation at the hip- 

 joint; disarticulation by antero-posterior flaps, cut 

 by transfixion ; the anterior flap is the longer of 

 the two and is made first ; the disarticulation is 

 effected before the posterior flap is cut. 3. For 

 chiloplasty ; removal of the diseased tissues, and 

 transplantation of a flap from the chin or the cheek. 

 4. For excision of the elbow ; a modification of 

 Moreau's incision, in which the outer vertical limb of 

 the H is omitted. 5. For excision of the upper jfao ; 

 it is done by three incisions : (a) an incision from the 

 external angular process of the frontal bone through 

 the cheek to the angle of the mouth ; (b) a short inci- 

 sion along the zygoma to meet the first ; (c) an incision 

 along the side of the nose and through the center of the 

 lip. Littre's : I. For enlerotomy ; occlusion of the 

 lower end of the intestine, with the formation of an arti- 

 ficial anus. 2. For inguinal colotomy ; it is performed on 

 the left side for opening of the sigmoid flexure ; an in- 

 cision from l l / 2 to 3 inches long is made parallel with 

 the outer part of Poupart's ligament, and about V 2 inch 

 above it. Lizars' (J-), a method of exposing the up- 

 per jaw by cutting through the cheek, from the angle of 

 the mouth to the malar bone. Loreta's : 1. For aneu- 

 rysm ; the insertion of a small wire into the sac. and 

 the use of electrolysis as well. 2. For stenosis of the 

 orifices of the stomach ; digital or instrumental divulsion 

 of the pyloric or cardiac orifice, following gastrotomy. 

 Lossen's, for neurectomy ; a modification of Lucke 1 s 

 operation in which the masseter muscle is not divided. 

 Lowdham's, a method of performing amputations ; it 

 is done by a single flap. Lubbock's, for lacrymal 

 fistula ; an incision is made into the anterior wall of 

 the lacrymal sac, followed by the introduction of a 

 grooved knife to the bottom of the duct, and the 

 passage of a leaden style. Lucae's, for strabismus : a 

 semicircular incision is made in the conjunctiva near 

 the cornea, followed by division of the tendon close to 

 the sclerotic. Lucas's: 1. For lumbar nephrectomy; 

 an oblique incision is made as for colotomy, supple- 

 mented by a vertical incision carried along the outer 

 edge of the quadratus lumborum muscle from the last 



rib to the iliac crest. 2. For umbilical hernia ; excision 

 of the sac and redundant skin, with suture of the ring. 

 Lucke's : 1. For excision of the hip; it is done by an 

 anterior incision in the long axis of the femur, com- 

 mencing-^ inch below and to the inner side of the 

 anterior superior iliac spine. 2. For neurectomy ; re- 

 moval of the second division of the fifth nerve 

 at the point of exit from the skull ; the incision is 

 made above the external canthus along the upper 

 border of the zygoma, and the spheno-maxillary fossa 

 is exposed by sawing and breaking through the arch. 

 Luke's: 1. A method of performing amputations: 

 the first flap is made by Langenbeck's method, and the 

 second by Vermale's method. 2. For iliac colotomy ; a 

 modification of Cripps' operation in which the in- 

 cision is made in a vertical direction and external to 

 the epigastric artery. Lund's, for talipes; the re- 

 moval of the astragalus. Luzardi's, for iridodialy- 

 sis ; by means of a special needle a portion of the iris is 

 drawn out through either the cornea or sclerotica, and 

 retained by adhesions. Lydston's, for varicocele; an 

 incision one inch or more in length is made parallel 

 with the spermatic cord and beginning just below the 

 external abdominal ring ; the cord and veins are ex- 

 posed, separated, and the veins ligated with a single 

 silk ligature ; after closure of the wound a clamp is ap- 

 plied and the redundant scrotal tissue removed. Mac 

 Cormac's (Sir IV.): I. For excision of the shoulder; 

 by a posterior vertical incision starting from the 

 angular projection on the inferior margin of the 

 acromion. 2. For genu valgum; division of the 

 femur from the outer side, above and parallel with 

 the articular surface. 3. For ligation of the popliteal 

 artery ; it is done from the front at the inner side ; the 

 artery is exposed by an incision behind and parallel to 

 the tendon of the adductor magnus. 4. For rhino- 

 plasty ; the Italian method, the flap being taken from 

 the inner aspect of the arm. 5. For suture of t/, 

 intestine ; the same as Lemberf s method, except that 

 only an external line of sutures is used. Macdon- 

 ald's, a method of performing embryotomy. 

 Affleck 's operation. Macewen's : 1. For aneu 

 rysm; a long pin with a tapering point is passed into 

 the aneurysm and the point is made to touch the oppo- 

 site wall of the sac; the point is then to be moved 

 over the inner surface of the aneurysm for ten minutes 

 for the purpose of causing irritation ; in this way each 

 point accessible to the point of the needle is to be 

 treated. 2. For genu valgum; a modification of 

 Chiene , s operation, the wedge being removed through 

 the same line of incision as in Ogstotis operation. ,;. 

 For the radical cure of inguinal hernia : the sac is 

 dissected out and separated from its connecti< 

 then so drawn upward by means of a suture ;i- b 

 form a pad upon the inner surface of the circumfer- 

 ence of the ring ; the ring and canal are then closed 

 by means of sutures. 4. For intubation of the larynx; 

 a long, cylindric tube, of the pattern of tl 

 elastic catheters, is introduced from the mouth in 

 the trachea through the larynx. 5. Osteotomy 

 genu valgum : supra-condyloid division of the femur 

 from the inner side. Mackenzie's: 1. For ampui 

 tion of the foot ; the flap is taken from the inner and; 

 plantar surface of the foot and ankle in performing « 

 Syme amputation. 2. For excision of the knee ; by rais- 

 ing an anterior U-shaped flap. Macleod's, 

 tation at the ankle-joint: a modification 1 

 operation, in which only the malleoli are removed, th< 

 cartilage on the under surface of the tibia being pre- 

 served. MacNamara's, for cataract-extraction; re 

 moval of the lens in its capsule without an iridectomv, 

 through a larg;e corneal incision extending outward. 



