OPERATIONS 



925 



OPERATIONS 



ions of the femur are made just below the trochanter 

 minor, one anteriorly, the other posteriorly; the bone 

 a fractured. Smith's ( T.) : I . For double hare- 

 the outer segments are pared and the parings re- 

 moved ; the prolabial flaps are then turned down from 

 the sides of the central tubercle. 2. Y ox uranoplasty ; 

 the utilization of the mucous membrane covering the 

 vomer as a means of bridging the cleft. Smyth's, 

 for ligation of the vertebral artery ; the incision is 

 commenced at the clavicle, and is carried upward 

 along the posterior border of the sterno-mastoid muscle 

 for three inches ; the process of the sixth cervical 

 vertebra is sought for as a guide. Snellen's: I. For 

 tnctival ectropion ; traction is exerted on the con- 

 tracted conjunctiva so that it becomes permanently 

 inverted, the sutures being passed through the highest 

 pari of the everted mucous membrane. 2. For 

 bion : two needles on the same thread are passed 

 parallel to each other some distance apart, from the 

 summit of the everted conjunctiva beneath the 

 skin and out about the margin of the orbit ; the two 

 ends are then tied over a roll of gauze. 3. For 

 entropion; a modification of Streatfield's operation, 

 in which, after grooving the tarsus throughout its 

 whole extent, sutures are used to effect the desired re- 

 sult. 4. For strabotomy ; a horizontal incision is 

 made in the conjunctiva over the middle of the ten- 

 Ion ; the tendon is then seized with forceps, and a snip 

 s made into it with the scissors ; the upper portion 

 >f the tendon is divided first, then the lower portion. 

 5. For trichiasis ; a loop of thread is passed, by means 

 if a needle, in the free margin of the lid as near as 

 possible to the offending hair ; the hair is caught in 

 he loop and drawn through the needle-tract. Socin's : 

 I. For the radical cure of inguinal hernia ; ligature 



an> 



d excision of the sac. 2. For the removal of tumors 

 of the thyroid gland ; incision through the normal 

 gland-structure and enucleation of the neoplasm. 

 Sonnenburg's: I. Y ox ectopia vesica ; the bladder is 

 Extirpated and the ureters united to the dorsal groove 

 bf the penis. 2. For resection of the bladder ; a 

 supra-pubic operation with removal of a tumor in- 

 volving the anterior wall of the bladder ; the bladder- 

 '■vound is closed by stitching the peritoneum over it. 

 Sotteau's, for the radical cure of inguinal hernia ; a 

 double invagination of the scrotum is made to fill the 

 anal. Soupart's, for amputation at the elbow-joint ; 

 in elliptic amputation, with the highest point of the 

 :llipse in front, the flap being taken from behind. 

 Spanton's : I. Y or fixity of the lower jaw; subcuta- 

 leous division of the adhesions between the condyle 

 Jid the glenoid cavity. 2. For the radical cure of 

 nguinal hernia; the subcutaneous method; after re- 

 luction of the rupture a small incision is made over 

 he fundus of the sac and the pillars of the ring are 

 losed with the screw-instrument. Spence's : 1. For 

 i mputation at the shoulder-joint ; this resembles Lar- 



!ey's operation, except that the longitudinal incision is 

 aade on the inner aspect of the arm. 2. For ampu- 

 ition of the thigh ; it is done by long anterior and 

 hort posterior flaps, the latter being cut from without 

 ward, and commenced two inches below the base 

 f the anterior flap. Sperino's, for cataract ; repeated 

 aracentesis of the aqueous humor. Spiegelberg's, 

 n prolapse of the uterus, with marked cystocele ; the 

 liddle of the lower portion of the anterior vaginal 

 all is united to the middle of the upper portion 

 f the posterior wall, after each has been denuded, 

 1 addition to the repair of the perineum. Squire's, 

 >r port-iuine marks ; multiple parallel incisions, 

 'tacke's, for middle-ear disease; incision through 

 ie skin, circumscribing the auricle posteriorly; the 



membranous meatus is shelled out of the osseous 

 canal ; the median upper part of the bony meatus 

 is cut away and the exposed malleus and incus re- 

 moved ; the superior wall is then chiseled to near 

 the drum-insertion ; then the posterior wall of the 

 meatus is cut away ; thus the attic, tympanum, an- 

 trum, and meatus are converted into one large cavity. 

 Star-operation, for transversely lacerated perineum ; 

 after denudation of a transverse strip, a median tri- 

 angular or bilateral figure is denuded across the trans- 

 verse strip. Stearns', for internal urethrotomy ; it 

 is done with a special dilating urethrotome. Steele's, 

 for deviated nasal septum ; a modification of Blandin's 

 operation, q. v. Stell wag's : I. Canthoplasly ; an 

 oblique blepharotomy or sphincterotomy. 2. For cat- 

 aract-extraction; a corneal flap-extraction. 3. For 

 trichiasis ; re-attaching the raw surface of the tarsus 

 to the ablated zone of hair-follicles, so that the border 

 that bears the cilia looks upward and that which has 

 the raw surface looks downward. Stevens', for 

 ligation of the internal iliac artery ; an incision about 

 five inches long is made parallel with the deep epi- 

 gastric artery and nearly % inch on the outer side of 

 it. Stevens' (G. T.), for muscular asthenopia ; par- 

 tial or graduated tenotomy of one of the ocular mus- 

 cles. Stilling's : I. Ovariotomy; the cautery is ap- 

 plied to the pedicle, which should be stitched in the 

 parietal wound. 2. Y or stricture of the nasal duct; 

 internal incision. Stillman's, for hemorrhoids ; the 

 patient is placed in the knee-chest position and each 

 mass is reduced by manipulation as for hernia, after 

 which a pile-bougie is introduced. Stimson's, for 

 fracture of the patella ; four small punctures are made 

 deeply through the skin at the margin of the patella, at 

 equal distances from it, ' m O' m A half-curved Hagedorn 

 needle armed with a heavy silk suture is carried in one 

 lower incision, through the ligamentum patellae, and out 

 the opposite incision, reentered at the point of exit and 

 brought out at the upper incision on the same side, 

 inserted again at the same point, made to transfix the 

 quadriceps tendon and emerge at the other upper in- 

 cision, introduced again at the same point and brought 

 out at the place of starting. The fragments are held 

 together by strong tenacula and the sutures tied tightly 

 and the ends cut short ; the incisions are then closed. 

 Stokes' (Sir IV.) : I. For amputation above the knee ; 

 the same as Gritti ' s operation, except that section of 

 the femur is made above the condyles. 2. For excis- 

 ion of the tongue ; a modification of Jaeger's opera- 

 tion. 3. Y ox flat-foot ; by removing a wedge-shaped 

 piece of bone from the head and neck of the astrag- 

 alus. 4. For single hare-lip ; the prolabium is formed 

 by tissue from both sides of the cleft by means of in- 

 cisions skirting the red margin ; the upper part of the 

 cleft is incompletely pared and the partially dissected 

 flaps turned back, while the edges of the skin are 

 brought together and the prolabial flaps drawn down- 

 ward and outward. Stoltz's, for cystocele ; it is also 

 called the purse-string and tobacco-pouch operation ; 

 denuding a circular patch on the anterior vaginal wall, 

 and running a suture around the margin and tying. 

 Streatfeild's : I. For atresia of the punctum lacry- 

 male ; slitting of the canaliculus. 2. For cataract- 

 extraction; it is made with a Sichel's knife without 

 counter-puncture, the wound being enlarged by a 

 sawing motion. 3. For entropion ; removal of a 

 wedge-shaped strip from the tarsal cartilage. 4. For 

 synechia; the same as Passavanf s operation, except 

 that a cutting-hook is used in place of forceps. Streat- 

 feild- Snellen's, for entropion ; like Streatfeild's ope- 

 ration, except that the groove in the tarsus is made 

 higher up. Strohmeyer's, for strabotomy; an incis- 



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