OPERATIONS 



j Button. Murray's, for ligation of the abdonu- 

 aorta ; the extra-peritoneal operation ; a curved 

 incision, with its concavity forward, and about six 

 inches in length, is made upon the left side of the 

 body, from the anterior extremity of the tenth rib to a 

 point about one inch to the inner side of the anterior 

 superior iliac spine. Mutter's, for chiloplasty ; the 

 formation of two quadrilateral flaps to fill the defect 

 caused by removing the diseased tissue. Myles', 

 i for amputation at the hip-joint ; a stout steel skewer is 

 thrust through the thigh from before backward, the 

 point entering an inch below Poupart's ligament and 

 just to the outer edge of the femoral artery ; it passes 

 to the inner side of the neck of the femur and emerges 

 a little above the gluteal fold ; an india-rubber cord is 

 passed around the ends in a figure-of-eight. Nail's 

 i (B. R- ), for internal urethrotomy ; it is done with a 

 special dilating urethrotome. Nassiloff 's, for esopka- 

 gostomy ; the formation of a fistulous opening between 

 the esophagus and the surface of the neck in cases of 

 stricture or tumor of the former. Neal's, for gastrot- 

 omy ; a parietal incision is made in a line extending 

 from the umbilicus toward the left false ribs. Nela- 

 ton's : I. For amputation through the foot ; subastrag- 

 aloid disarticulation by dorsal and plantar flaps, larger 

 on the inner than on the outer side. 2. For enterotomy ; 

 the abdomen is opened in the right iliac region by an 

 incision parallel to and a little above the outer portion 

 of Poupart's ligament ; the first coil of intestine that 

 presents is drawn into the wound. 3. For epispadias ; 

 it is done by reversed flaps, one being obtained from 

 the median line of the anterior abdominal parietes, 

 the other from the anterior surface of the scrotum. 4. 

 For hare-lip ; an incision is made around the upper 

 angle of the cleft and the lower edge is turned down- 

 ward, so that the wound becomes diamond-shaped ; 

 the sides are then brought together and sutured. 

 5. F 'or lithotomy ; the pre-rectal method, correspond- 

 ing with the bilateral operation, with the addition of a 

 careful dissection to obtain more space between the 

 rectum and the bulb of the urethra, to avoid wound- 

 ing the latter. See Lithotomy. 6. For the removal 

 of a nasopharyngeal polypus : it is done through the 

 mouth, by exposing the hard palate and drilling two 

 holes in it, so that the intervening bone can be re- 

 moved. 7. F 'or proctotomy ; the external method ; 

 \ the left index finger is introduced as far as the stricture, 

 and, with this as a guide, the soft parts below the 

 J stricture are divided in the median line by a blunt- 

 ! pointed bistoury. 8. For rhinoplasty ; two trapezoid 

 j flaps are taken from the cheeks, each flap being intended 

 to form the corresponding half of the new nose. 9. For 

 ! urethroplasty ; the edges of the fistula having been 

 pared, the surrounding skin, to the extent of about an 

 - dissected up subcutaneously, through an open- 

 ing made below the fistula, and the fistula is closed by 

 sutures. 10. For webbed fingers ; the same as Didofs 

 n. Neudorfer's: I. For ectopia vesica; a 

 modification of Trendelenburg' s operation, in which the 

 \c synchondroses are not separated, but approxi- 

 of the margins is made possible by two lateral 

 incisions through the abdominal wall ; the pubic bones 

 ', are brought together by sutures. 2. For excision of 

 j the shoulder ; it is done by a curved supra-acromial 

 j incision, the acromion being sawn through and the 

 head of the bone thrust out. Neugebauer's, for 

 us uteri ; the same as that subsequently de- 

 scribed by Le Fort, and best known by his name. 

 Newman's, for nephrorrhaphy ; in addition to stitch- 

 ing the kidney to the abdominal parietes, the fibrous 

 capsule is split and separated from the surface of the 



919 OPERATIONS 



kidney ; the resulting adhesion thus aids in fixing the 

 kidney. Nicoladoni's, for talipes calcaneus ; in cases 

 of paralysis of the calf-muscles, with the peroneal 

 muscles intact, the tendo Achillis is cut and sewn to the 

 peroneal tendons. Norton's, for z^ebbed fingers ; 

 small triangular flaps are raised between the knuckles 

 on the dorsal and palmar aspects ; the webs are then 

 cut through the bases of the flaps, which are stitched 

 together. Noyes' : I. For blepharoplasty ; (a) The 

 formation of a bucco- temporal flap, sliding the whole 

 cheek, with the shortened lid, inward and upward. 

 (b) The formation of a naso-buccal flap. 2. For in- 

 flammatory secondary cataract ; the formation of an 

 artificial pupil ; a hole is made in the obstructing mem- 

 brane with a v. Graefe knife, and this is enlarged by 

 tearing. 3. For entropion ; cure by a plastic operation. 

 4. f 'or staphyloma ; incision of the limbus, followed by 

 total avulsion of the iris. 5. For strabismus ; ad- 

 vancement of the elongated tendon. Nuel's, for 

 corneoscleral rupture ; the wound in the sclera is re- 

 opened by making a section with a knife, and the sur- 

 rounding conjunctiva is drawn over the opening by 

 means of a special suture. Nunneley's, for excision 

 of the tongue ; it is done by a suprahyoid incision and 

 the use of the ecraseur. Nussbaum's, a method 

 of performing ovariotomy ; the pedicle is tied in sec- 

 tions with catgut and dropped into the pelvic cavity. 

 Oberst's, stomatoplasty ; the defects of the mucous 

 membrane of the cheek are covered with tissue re- 

 moved from the upper or lower lip. Obre's, for the 

 radical cure of obturator hernia ; by cutting down 

 on the sac as in other hernias. Odhelius's, for 

 iridotomy ; the same as Reichenbach s operation. 

 O'Dwyer's, for intubation of the larynx; the same 

 as Mace-Men's operation, except that a shorter tube 

 of metal is introduced into the larynx. Oettin- 

 ger's, for trichiasis ; an incision is made in the inter- 

 marginal space, and is carried to a point above the 

 upper border of the tarsus, so that all the skin that 

 covers the tarsus can be displaced upward. Ogston's 

 {Alexander): I. F 'or extreme ' flat-foot ; excision of the 

 astragalo-scaphoid joint in a wedge-shaped piece, and 

 the fixing of the astragalus and scaphoid together with 

 pegs. 2. Osteotomy for genu valgum ; division of 

 the internal condyle of the femur obliquely, from before 

 backward. 3. For opening the frontal sinuses ; it is 

 done by trephining in the middle line of the frontal 

 bone. 4. F or varicocele ; subcutaneous ligation with 

 silk ; the same as Keyes' operation. Oilier' s : 1. 

 For excision of the elbozv ; by lateral incisions, the 

 main one external and "bayonet" -shaped, the inter- 

 nal one short and vertical. 2. For excision of joints ; 

 the subperiosteal method, in which the whole of the 

 periosteum of the involved district and the capsular 

 ligament are preserved. 3. For excision of the knee ; 

 by Moreau s incision and the carrying out of the 

 periosteal method. 4. For excision of the scapula; 

 one incision along the spine, and a second along the 

 internal border of the scapula, and the subperiosteal 

 removal of the bone. 5. For excision of the shoul- 

 der; by a single anterior vertical or oblique incision 

 and the carrying out of the periosteal method. 6. 

 For excision of the -wrist; the subperiosteal method 

 by two dorsal incisions, after those made by Backel 

 and Lister. 7 . For genu valgum : section through 

 the epiphyseal cartilage. 8. For the removal of a 

 naso-pharyngeal polypus ; it is done through the nose 

 by an osteoplastic operation ; the nasal bones are 

 exposed and sawn through in the upper portion, so 

 that the nose can be turned downward. 9. For 

 rhinoplasty : two diverging incisions are commenced 

 in the median line of the forehead and carried down- 



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