Incision

“ Syme, the fore-arm may be flexed, and the bones as easily displayed, cleaned, and removed, as in the operation for disease. In this operation, as there is less thickening of the skin and subjacent textures, and in consequence more risk of deficiency and even sloughing of the flaps made by the H-shaped incision, a single straight incision will serve the purpose admirably.
Partial incisions of the elbow-joint are, as a rule, less successful and more dangerous to life than complete ones, except in cases of excision for anchylosis. ”

“ Then apply iodoform gauze over the wound and change the dressings as often as is deemed necessary—two or three times a day. In severe cases open the wound thoroughly, even by further incision, clean out the contents of the wound, such as foreign matter, bloodclots, exudate, or perhaps pieces of bone that may have been overlooked, using a small, sharp spoon curette for the purpose. ”

“ In most cases it is possible, and in nearly all advisable, to excise the joint by means of a less complicated incision. Thus one long vertical incision at the posterior surface, with its centre about midway between the ulna and the external condyle, with a transverse{122} incision at right angles to it, and reaching almost to the internal condyle, has been often practised with a very good result. ”

“ Straight incisions are to be made in the legs, as in the muscles and tendons; and nerves, arteries, and vital parts are to be avoided, taking care of their safety by sometimes making a straight incision and sometimes a transverse one into the abscess, according to the circumstances of each case. When the abscesses are small we make one incision, but when they are larger we make more, always dividing the thinner parts, and those which are most convenient for the escape of the matter. ”

“ When the swelling is much raised up to a point, unconcocted, thin, and devoid of vitality, we must cut out a piece either like a triangle, or like a myrtle leaf, or of some other angular figure, because the circular is unfavorable to cicatrization. Those which are not pointed we open by a simple incision, and when we find a sinus, if the part is fleshy and the skin proper for uniting, we only make such incisions into the part as will allow the matter to be discharged; but if it be thin and very devoid of flesh we make a simple incision along its whole length ”

“ This operation is termed episiotomy, and the incision is sutured after labor just as a tear would be. It is the belief of those who perform this operation that the clean-cut incision heals more satisfactorily than an irregular tear, and that by directing the incision to the side, away from the median line, the integrity of the rectal sphincter is preserved, even though the perineum tears beyond the end of the incision, when distended during the birth of the head. ”

“ In opening the various organs an incision should be made which will expose the greatest amount of surface at one cut. Never make a number of small and always unsatisfactory incisions in an organ. In opening certain organs like the brain and heart, the incisions are so planned that the parts of the organ may be folded together, and, if necessary, their relations to one another and the whole organ studied. ”

“ The body being placed on its back, and the operator standing on the right side, an incision is made through the skin, fascia, and muscles from the top of the sternum to the pubic bone, passing to the left of the umbilicus and dividing everything down to the sternum and the subperitoneal tissue. A small incision is now made through the peritoneum below the ensiform cartilage. Into this opening two fingers of the left hand are inserted, and by spreading the fingers and holding the knife horizontally the peritoneum can be divided to the pubes without injuring the intestines. ”

“ Celsus directs the surgeon, when water is contained in a hernial tumour, to make an incision in the groin, if the patient be a child, unless the largeness of the collection prevent; but in adults, and when the swelling is great, he recommends him to make it in the scrotum. Then if the incision be in the groin, the coats are to be drawn up there and the water discharged; but if in the scrotum, and if the disease be seated there, nothing more is to be done but to evacuate the fluid, and remove any membranes which may happen to contain it ”

“ A long incision is generally preferable, and, when the neck is fat, should commence over the middle of the thyreoid cartilage. The skin and superficial fascia are divided between the two anterior jugular veins, and any bleeding is controlled. The incision is repeated so as to divide the deep fascia lying between the sterno-hyoid muscles, close to one another in the upper part of the incision, and these are separated with the knife. It is now advisable to pause and to seize the bleeding points, allowing the pressure forceps to fall on both sides of the wound to act as retractors. ”

“ As soon as they are nearly marriageable, an incision is made in the under-lip, and a bone passed through it, which is exchanged from time to time for a thicker one, that the opening may be continually widened. ”

“ Should a hyperplasia of connective tissue result from such an operation, a small linear incision, under four per cent eucain anesthesia, should be made directly over the greatest prominence, through which the offending mass can be removed by the aid of a small hooked knife or a fine pair of curved scissors.
The mass should be removed beyond the plane of the skin ”

“ The incision should include the skin and subcutaneous tissue. The V-shaped flap is dissected up and the lid liberated from the underlying scar tissue. The incision is then sewn up in the form of a Y (Fig. 155) . Temporary tarsorrhaphy (see p. 266) is always desirable. Subsequent shortening of the lid margin by the Argyll Robertson method is sometimes necessary.
Denonvillier’s operation. This procedure is useful to remedy an ectropion of the outer portion of the lower lid by the transposition of flaps at the outer canthus.
Instruments. Scalpel, dissecting and artery forceps, scissors, sutures. ”

“ After the incision we apply the instrument called hypospathister, and extend the division from the left temple to the middle incision, dividing all the intermediate substance along with the pericranium; then we push a spatula from the middle one to the rest, and applying the point of a sharp-pointed knife to the first division, so that its sharp side may be turned to the flesh within the skin, and the blunt one to the bone, we push it as far as the middle division, cutting through all the vessels which descend from the head to the eyes, but not comprehending the external skin. ”

“ With the long section-knife a main incision is made deep into the organ, from left to right, about a hand’s-breadth above the lower border. Parallel incisions to the main incision may be made. After the examination of the cut surface the organ is dropped back into the abdomen. When the liver is to be weighed and measured it is [Pg 145] removed from the body by cutting first the ligamentum hepatoduodenale, examining, as they are cut, the common duct, hepatic artery and the portal vein. The left lobe of the liver is then taken in the left hand and raised as high as possible. ”

“ By the use of the direct incision, make a cut with a sharp scalpel, about three inches long in the median line of the body over the abdomen. Start the cut about one inch below the ensiform process of the sternum and cut toward the navel. After a cut has been made three inches in length on the skin, direct the scalpel downward so that it enters the abdomen. Place the index and second finger in the incision thus made pressing the organs from the abdominal wall, and carefully cut upward between the two fingers. This will prevent the operator cutting any of the underlying intestines. ”

“ The skin incision must be sufficiently extensive to give access to the whole of the affected area, and to avoid disfigurement should, whenever possible, be made in the line of the natural creases of the skin. ”

“ For a hunter, two incisions are usually made, the second being about two inches below the first, and likewise as nearly as possible in the centre of one of the bones; the reason of which is, that the incision, in order perfectly to divide the muscles that bring down the tail, must not be so deep, as, in the neighbourhood of a joint, to endanger the wounding of the ligament which ties the bones together, or the substance which is interposed between the joints, and thus by destroying the joint to render the tail deformed. ”

“ The form of incision is somewhat sickle shaped, the upper curvature of the incision following the inferior border of the helix and extending well into the fossa of the helix, as shown in Fig. 136. Where the antihelix is particularly large a triangular section may be removed, as shown at A, with a corresponding shortening of the helix flap at B. The latter gives more contour to the ear as well. ”

“ The best incision is probably one which (Fig. xxvii. C) commences at the angle of the mouth opposite the healthy portion of jaw, extends down to the place at which the saw is to be applied and then along the base of the jaw past the middle line to the other point of section. The flap is to be thrown up and the bone cleared. The next point to be noticed is, that when, in clearing the bone behind, the muscles attached to the symphysis are divided, the tongue loses its support, and unless watched may tend to fall backwards, embarrassing respiration and even perhaps choking the patient. ”

“ This procedure should always be done with the patient thoroughly under the influence of an anæsthetic, and should occupy at least five or six minutes.
This operation is perfectly safe, but, as it is no less severe than the operation by incision, and as in some cases it fails to effect a cure, I can see no advantage in adopting it instead of the more satisfactory and always successful plan of treatment by combined dilatation and incision. It may be found preferable in some cases on account of the prejudice of patients against the use of the knife. ”

“ An incision is to be begun opposite to and on the outside of the extremity of the lobe of the ear, and carried downward in a straight line, until it reaches a little below the angle of the jaw, at the distance of nearly half an inch, more or less, as may be found most convenient from the form of the neck. ”

“ Fortunately our operating room was ideal, with its white enamelled walls and marble basins, its rubber covered floor, the most modern of surgical appliances, and, most important of all, a staff of highly trained nurses—it was as ideal as science could make it.
With a bright keen knife the incision was made down to the bone. Alas! It was hopelessly fractured. For a space of several inches there was nothing but tiny fragments, and the one long loose piece we had seen in the X-ray plate. The colonel turned, and said:
"What a pity! The space is so large, the bone will never regenerate. ”

“ When the Patient is laid upon his Back, an Incision is to be made on the Tumour to the Fat, by griping the Skin, if it be possible, or else it may be done without taking it up. Then the Membranes are to be divided with a Fleam to lay open the Peritonæum, for fear of cutting the Intestine ”

“ In performing extraction, the veins are first to be made to swell by putting the limb into hot water, applying fomentations, and taking strong exercise; and then a longitudinal incision is to be made in it, either at the knee or the ankle. ”

“ Having, therefore, made a lunated incision below the breast, and dissected away the skin, we unite the parts by sutures. But if, as in women, the breast incline downward, owing perhaps to its magnitude, we make in it two lunated incisions, meeting together at the extremities, so that the smaller may be comprehended by the larger, and dissecting away the intermediate skin, and removing the fat, we use sutures in like manner. But if, through mistake, we should cut away too little, we must again remove what is redundant, and apply the remedies for fresh wounds. ”

“ We operate upon them as upon scrofulous tumours, by incision, dissection, sutures, and the rest of the treatment, only avoiding to wound the membrane, lest its fluid contents be poured out and obstruct the operation, and lest a part of it should be left behind, which often occasions a renewal of the complaint at the wrists, ankles, and the moveable parts about joints, as a scrofulous tumour does in like manner, if the whole or a part of it be left behind. If any such thing be left it will be better not to sew up the wound, but to consume the remainder with septic applications. ”

“ Pathology.—The pathology will depend to a great extent upon the degree of the inflammation. Ulceration may take place or there may be perforation.
Treatment.—If, after an operation, reopen the incision made by the surgeon, relieve the gas pressure on the intestines by incising them; surround the intestines with hardening compound; then inject an artery, using half strength fluid for the first 64 oz., followed by enough normal fluid to secure preservation. Drain the blood during the injection by one of the drainage processes. ”

“ In cases of violent fixed pains, with swelling and threatening of matter forming, incision may be sometimes practised with relief to the patient, but is not to be had recourse to unless there is a risk of the bone suffering. Local abstraction of blood is advantageous, and may, if necessary, be followed by counter-irritation, as the application of blisters or sinapisms. Friction with stimulating substances, or with opiate liniments, is often useful when the disease begins to yield, the pain and puffiness of the parts being thereby dispelled. ”