OPERATIONS 



924 



OPERATIONS 



scraping with Gottstein's curet while the patient's head 

 is hanging over the edge of the table, to prevent the 

 blood and fragments from entering the air-passages. 

 Senn's (N.) : I. For amputation at the hip- joint ; by 

 means of a skewer as in Afyles' operation. 2. ¥ or gastro- 

 enterostomy ; it is done with the use of perforated bone- 

 plates, as in Senn's operation for intestinal anastomosis. 

 3. For intestinal anastomosis ; the diseased tissue is 

 excised and the ends of the bowel entirely and per- 

 manently closed, the continuity of the canal being 

 restored by means of " intestinal anastomosis by lateral 

 approximation" with the use of bone-plates. 4. For 

 pancreatic cyst; two stages : (1) the bottom of the 

 wound is packed over the cyst-wall with iodoform- 

 gauze ; (2) the cyst is opened after six or eight days. 

 5. For suture of the intestine; a modification of 

 Jobert' 's operation, in which a soft, pliable rubber 

 ring, made of a rubber band transformed into a ring 

 by fastening the ends together with catgut sutures, is 

 placed within the upper segment of the bowel ; the 

 sutures in transfixing the bowel pass through the upper 

 portion of the ring. Serres' : I. For blepharoplasty ; 

 the same as Knapp's operation. 2. For restoration 

 of the angle of the mouth ; two triangles are so fashioned 

 that their bases meet at the site of the new angle of 

 the mouth. Seton Operation, any operation in 

 which a seton is used to give rise to inflammatory 

 adhesions. Sexton's, for otorrhea; it consists in 

 the removal of any traces of the membrana flaccida, 

 of the membrana vibrans and the malleus and incus, if 

 present, and of the granulation and carious tissues. 

 Sharp's, for iridotomy ; the same as Cheselden' 's oper- 

 ation, except that the needle is introduced through the 

 cornea. Sharpe's, a method of performing amputa- 

 tions ; the same as Souparf s operation. Sigault's, for 

 otherwise impossible labor; pubic symphysiotomy. Sig- 

 norini's, for the radical cure of hernia ; similar to 

 Gerdy's operation, except that a female catheter takes 

 the place of the finger, and three pins are used instead 

 of sutures. Simon's [J.) : 1. P'or ectopia vesica? ; com- 

 munication between the bladder and the bowel is 

 effected by means of threads passed from the ureters 

 into the rectum. 2. For elongation of the vaginal 

 portion of the cervix ; it consists in the removal of a 

 wedge-shaped section of the elongated cervix, the 

 apex of which extends high up into the cervical wall, 

 while the base is formed by the lower portion of the 

 lips. 3. For exploration of the rectum and adjacent 

 parts ; it consists in introducing the hand or the hand 

 and arm of the operator into the bowel. 4. For lacer- 

 ation of the perineum ; the edges are freshened ; then 

 sutures are first passed so as to include all the 

 denuded rectal mucous membrane ; each suture com- 

 mences and ends in the rectum, and is tied as soon as 

 passed ; the wound is then closed as usual. 5. For 

 uretero-vaginal fistula ; an opening is made into the 

 bladder where the ureter empties into the vagina; 

 through this opening a sound is passed from the 

 bladder into the ureter; the uretero-vaginal wall is 

 slit up from the bladder on the sound ; the margins of 

 the wound are daily separated by a sound until 

 cicatrization has taken place ; the vaginal fistula is 

 closed at a second operation. 6. For vesico-vaginal 

 fistula ; adaptation of the pared margins, the mucous 

 membrane of the bladder being included in the 

 abrasion ; the stationary catheter is not retained after- 

 ward. Simpson's [Sir J.): 1. For obpherectomy ; 

 acupressure is applied to the pedicle inside of the 

 abdominal wall. 2. For stenosis of the cervix uteri; 

 bilateral incisions through the whole length of the 

 cervical canal. Sims' (Marion): I. P'or ante- 

 flexion of the uterus ; incision of the posterior lip of 



the cervix in the median line up to the point of flexion, 

 to permit of communication between the upper por- 

 tion of the uterine canal and the posterior vaginal fornix. 

 so that the discharges may escape the curve of flexure. 

 2. For cholecystotomy ; the gall-bladder is stitched to 

 the abdominal wound and a permanent fistula is estab- 

 lished. 3. For colporrhaphy ; denudation of a V- 

 shaped surface on the anterior wall of the vagina and 

 apposition of its arms by sutures. 4. For lithotomy 

 [in the female) ; the parts are exposed as for the oper- 

 ation for vesico- vaginal fistula; a curved director is 

 passed through the urethra into the bladder, and made 

 to project on the anterior vaginal wall ; this is cut down 

 upon, and the stone extracted ; the opening is not to 

 be closed. 5- f° r supravaginal elongation of the 

 cervix ; the cervix is amputated with scissors, and the 

 mucous membrane is drawn over the stump and united 

 with four stitches. 6. For trachelotomy ; division of 

 the cervix on either side up to the vaginal junction, 

 and division of the cervical canal as high as the in- 

 ternal os ; if the cervix is flexed, the lip on the con- 

 vex side is divided, and the canal is enlarged as before. 

 7. Y ox vesico-vaginal fistula ; coaptation of the pared 

 margins, the abrasion not including the vesical sur- 

 face ; retention of a catheter afterward. Sinclair's, 

 for diseased Fallopian tubes ; free incision per vaginam, 

 and subsequent washing out of the empty tubes. 

 Skene's {A. J. C), for anteflexion of the uterus with 

 imperfect invagination of the cervix into the vagina ; 

 transverse division of the anterior vaginal wall after 

 the anterior column of the vagina has been put on the 

 stretch by drawing the cervix backward toward the 

 hollow of the sacrum ; the upper and lower edges of 

 the incision are drawn apart by stretching the incised 

 portion, and sutures are introduced from the sides, 

 transforming the transverse incision into a longitudinal 

 incision. Skewer Methods, for amputation through 

 the hip-joint. See Myles' , Spence 1 s , and Wyetk's op- 

 erations. Skey's : I. For tarso- metatarsal amputa- 

 tion ; disarticulation through the outer three and inner 

 joints, the base of the second metatarsal bone being 

 sawn through. 2. For rhinoplasty ; two lateral flaps 

 made from the side of the nose upon the cheek are 

 brought into the mesial line. Skutsch's, for sa: 

 omy ; after ascertaining by aspiration the nature of the 

 contents of a tube which has been converted into a 

 serous cyst, an oval piece about half an inch wide is 

 excised from the abdominal end, and the mucous ami 

 serous surfaces are united with silk sutures around the 

 opening ; the new ampulla should be sutured to the 

 ovary. Smith's ( Greig) : I. For ectopia vesica: 

 a modification of Wood's operation in which the flap 

 are made larger. 2. For extreme intestinal obstrm 

 Hon ; an artificial anus is made, and the intestine is 

 patiently milked to squeeze out the feces. 3. flw 

 removal of the uterine appendages ; it is done by ab- 

 dominal incision. Smith's (G. A'.), for internal ure- 

 throtomy; it is done with a special dilating urethrotome. 

 Smith's (//.), for hemorrhoids; crushing by mear 

 of a clamp, and applying the Paquelin cautery to th< 

 stump after cutting away the projecting part. Smith' 

 (JV.): I. ¥ or amputation at the knee-joint ; it i- done 

 by a large anterior and a smaller posterior skin flap. • 

 A method of performing ovariotomy : the arteries ol BD 

 pedicle are tied separately and the ligatures (strips a 

 from a kid-glove) are cut short, the pedicle !' 

 dropped inside. Smith's (.V.): 1. for amputatk 

 through the knee-joint ; it is done by " lateral hootk 

 skin-flaps," the incision commencing in front a 

 one inch below the tubercle of the tibia, and beat 

 carried up to the center of the articulation behind, j» 

 patella being preserved. 2. Osteotomy: two paltll 



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