OPERATIONS 



to the skin near the eye. Tiffany's, for union of tendon 

 and flap; in amputation of fingers at the joint between 

 ; the first and second phalanges, the stitch that unites 

 the skin is passed through the tendon and its sheath. 

 Tillaux's, for cholecystenterostomy : it is performed in 

 three stages : (I) the gall-bladder is fixed by sutures to 

 a loop of the jejunum and a biliary fistula is established 

 by uniting the margins of an opening made in the gall- 

 bladder to the parietal wound ; (2) after about nine 

 davs an artificial communication is established between 

 the bowel and the gall-bladder through the fistula ; 

 1 (3) eighteen days later the biliary fistula is closed 

 bv a plastic operation. Travers', for cataract-extrac- 

 tion ; the capsule is divided and the lens is displaced 

 into the anterior chamber ; it is then removed through 

 a small corneal incision. Travignot's, lor amputation 

 of the leg : it is done by a large posterior flap and a 

 short anterior one. Trelat's : I. For Dupuy- 

 tren's contraction; division of the attachments be- 

 tween the skin and fibrous bands, followed by division 

 i of the bands themselves. 2. F 'or internal urethrotomy ; 

 a special urethrotome is used and the stricture is 

 cut both ways. Trendelenburg's: 1. For ectopia 

 vesica; ; narrowing of the defective area by approxi- 

 mating the two innominate bones, after division of the 

 sacroiliac synchondrosis on either side. 2. For flat- 

 j foot; supra-malleolar osteotomy. 3. For staphylo- 

 \ plasty; the same as Schonbeins operation. Treves' 

 • (F.) : I. for spinal abscess ; a vertical incision, two and 

 a half inches in length, is made in the loin, midway 

 between the last rib and the crest of the ilium, the 

 incision to be parallel with the vertebral side of the 

 outer border of the erector spins muscle. 2. For 

 ununited fracture of short bones ; the fragments are 

 1 in position with a pair of modified Malgaigne ' s 

 iks. 3. For varicocele ; exposure of the veins, the 

 application of two ligatures and excision of the included 

 portion. Treves' (IF. K.), for excision of the knee ; 

 it is done by two vertical lateral incisions. Triangu- 

 lar-flap operation, for lacerated perineum . See Dun- 

 can' s operation. Tripier's : 1. For amputation through 

 the foot ; a modification of Choparf s operation in which 

 the 05 calcis is sawn through horizontally at the level of 

 the sustentaculum tali and its lower portion is removed. 

 2. For blepharoplasty ; a flap is taken from the upper 

 lid to close a deficiency in the lower lid. Valette's : 

 I. For the radical cure of hernia ; an attempt is made 

 to close the canal by causing an eschar by means of 

 Vienna paste. 2. For the removal of a nasopharyn- 

 geal tumor ; by an operation similar to those of Berard 

 and Hurler, but of less extent ; the anterior and 

 inner wall of the maxillary sinus is removed, and the 

 sinus is thus opened into the nasal cavity. Van 

 Best's, for the radical cure of hernia ; subcutaneous 

 suturing of the inguinal rings. Van Buren's, for 

 prolapsus ani ; a linear cauterization of the mucosa 

 with the Paquelin cautery. Van Millingen's : 1. 

 For entropion ; the mucosa is transplanted into the 

 wound made by an incision at the lid-margin. 2. 

 For trichiasis ; the covering of the wound made in 

 Arlt's operation by mucosa from the patient's lips 

 or from the conjunctiva of a rabbit, instead of with 

 skin. Veit's : I . A method of performing embry- 

 otomy : evisceration followed by simultaneous trac- 

 tion on an arm and the breech, the fetus being de- 

 livered doubled up. 2. For otherwise impossible labor ; 

 the same as Porro- J'eit's operation. Veitch's, for am- 

 putation at the hip-joint ; the same as Fsmarch' s opera- 

 tion. Velpeau's : I. For excision of the upper jaw : 

 an incision is commenced at the angle of the mouth and 

 is carried in a curved direction, through the cheek to 



927 OPERATIONS 



end over the center of the malar bone. 2. For excision 

 of the wrist ; by raising a dorsal flap. 3. For iridotomy ; 

 a long double-edged knife transfixes the cornea, passes 

 through the iris to the posterior chamber and back to 

 the anterior chamber, through the cornea again, and a 

 flap is cut ; this leaves a triangular opening in the iris. 

 4. For preternatural anus ; removal of the adventi- 

 tious tissue around the preternatural anus, and suturing 

 of the wound. Vermale's: 1. A method of per- 

 forming amputation ; the ordinary double-flap opera- 

 tion, the flaps being cut by transfixion whenever pos- 

 sible. 2. For amputation of the arm ; by lateral flaps 

 marked out by a skin-incision, the remaining soft parts 

 being divided by transfixion ; the inner flap is cut the 

 longer. 3. For amputation of the thigh; by lateral 

 flaps of the same size and including all the soft parts 

 down to the bone ; both flaps are cut by transfixion. 

 Verneuil's : I. For amputation through the foot ; 

 subastragaloid disarticulation, the incision commenc- 

 ing over the outer tuberosity of the os calcis and being 

 carried forward to and over the dorsum of the foot, 

 just behind the base of the metatarsal bones and 

 finally sweeping across the sole to the point of com- 

 mencement. 2. For iliac colotomy ; a nearly vertical 

 incision is made, and a knuckle of gut is transfixed 

 and kept in place by two needles which lie on the 

 parietes ; the exposed bowel is then stitched to the 

 margins of the parietal wound and the protruding 

 knuckle is excised. 3. r 'or proctotomy ; the rectum 

 is first divided into lateral halves with the ecraseur, 

 and the subsequent dissection is done with the galvano- 

 cautery knife. 4. Y ox rhinoplasty ; two flaps from the 

 cheeks and forehead are superimposed to secure 

 elevation of the sunken nose. 5- ^ or stricture of the 

 rectum ; the same as Lenti's operation, except that a 

 posterior incision only is made. Vidal's \de Cassis) : 

 I . For gastrotomy, the parietal incision is made in the 

 middle line. 2. For varicocele; subcutaneous con- 

 striction of the veins by means of wire ligatures. Der 

 Villard's ( Carron) : 1. For ectropion; shortening of 

 the skin of the lid in a transverse direction. 2. For 

 iridotomy; the same as Maunoir' s operation. Voil- 

 lemier's, for internal urethrotomy ; it is done with a 

 modification of Maisonneuve ' s urethrotome. Volk- 

 mann's : I. For amputation at the hip-joint ; the same 

 as Es march's operation. 2. For excision of the rectum ; 



(a) For a circumscribed growth ; dilate the anus ; pull 

 down the diseased portion ; remove by incision ; suture. 



(b) For disease involving the circumference of the bowel, 

 but not the anus; divide the anus forward in the 

 perineum and backward to the coccyx ; remove the 

 growth by a knife or scissors, and the fingers, and 

 stitch the healthy mucosa together ; deep drainage ; 

 suture, (c) For disease involving the circumference of 

 the bozvel, and part or all of the anus ; make the anterior 

 and posterior incisions as directed ; then carry a circular 

 incision around the sphincter, and dissect out the 

 growth ; the healthy mucosa is stitched to the skin- 

 border; drainage; suture. 3. Hepatotomy for hydatid 

 cyst ; it is performed in two stages ; in the first, adhesion 

 is secured between the parietal peritoneum and the he- 

 patic peritoneum over tie seat of puncture ; the second 

 stage consists in incising the adherent cyst after some 

 days. 4. For hydrocele; by a free incision in the 

 tunica vaginalis and stitching the serous membrane to 

 the skin. 5. For lupus ; erasion with a curet. Von 

 Graefe's (Alfred). See Graefe's operations. Von 

 Hippel's. See v. Nippers operations. Von Wal- 

 ther's, for tarsorrhaphy ; paring of the borders of the 

 upper and lower lids adjoining the external angle and 

 securing the denuded surfaces together. Waldau's, 

 for cataract-extraction ; this differs from the linear 



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