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A Handbook of Operative Surgery and Surgical Anatomy. With Chapters on Instruments PDF

470 Pages·1936·17.55 MB·English
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A Handbook of Operative Surgery and Surgical Anatomy with Chapters on Instruments by Karuna K. Chatterji, F.R.C.S.L, LIEUT.-COLONEL, I.T.F., Honorary Colonel, Calcutta University Training Corps Professor of Surgery and in charge of the Department of Surgery, Carmichael Medical College, Calcutta ; Fellow of the University of Calcutta ; Fellow of the State Medical Faculty, Bengal ; Fellow of the Royal Society of Tropical Medicine, London ; Visiting Surgeon, Chilta- ranjan Hospital ; Consulting Surgeon, Chittaranjan Seva Sadan, Calcutta ; Author of 4 Tropical Surgery and Surgical Pathology ' and ' Syphilis with special reference to the Tropics ' With 282 illustrations, 17 in colour Third edition, re-written and enlarged BUTTERWORTH & CO. (INDIA) LTD. AVENUE HOUSE, CHOWBINGHEE SQUARE, CALCUTTA BOMBAY: JEHANGIR WADIA BLDG., ESPLANADE ROAD MADRAS: 317 LINGA CHETTY STREET 1936 ©education 2Co tlje sacreù memorg of tije late JUefc, Protap CHjunuer JHojoomtiar, tlje inspiration of mg bogfjooti anto a guitie in later gears. PREFACE As a science Surgery is progressive ; as an art it is under- going constructive evolution. The teaching and practice of Surgery must keep pace with the rapid advances that are con- stantly taking shape, and as is only natural, the Indian Medical Council, the various Universities and the Faculties of Medicine are making increased demands on teaching centres, the courses of instruction synchronise with the latest advances in the science. This is indisputably true, and text-books must of necessity be re-edited continuously. With regard to the present book, I had held up the manus- cript of the third edition until the ideas of various authorities had become standardized as was bound to be the case, where all are working for a common end. I found this essential at the present time, owing to conflicting methods and was forced to delay pub- lication to render the book of greater utility to teachers, pupils and practitioners. The study of anatomy is the landmark of the Renaissance of medicine, and gross anatomy in its relation to surgery, particularly to operative surgery, has a most practical and direct bearing on the subject. In schools of medicine, the department of Surgery is responsible for the proper approach to gross anatomy. With these ends in view, I have attempted to deal in detail with regional, topographic and organ anatomy, elaborating surgical approaches in sequential order to pathologic conditions for which particular operations are planned. It is my hope that this will help the student to anticipate and visualise matters, and infuse in the practitioner a sense of confidence and preparedness to meet eventualities and unforeseen conditions in the wards and operating theatres. I have felt it incumbent on me to introduce much additional matter in every chapter and also to add new chapters. For instance new matter will be found in the chapters on operations on nerves, muscles, bones and joints. New chapters on the surgery of the Central and Sympathetic Nervous Systems and the Thorax have been introduced, and several additional chapters on Abdominal and Urogenital Surgery have been added. The last chapter in the text is on Electrosurgical methods of operation. Tropical Surgery has become more or less a special branch and this is why the short chapter on this has been deleted and references in the text made to my book on Tropical Surgery and Surgical Pathology (John Bale Sons & Danielsson, London). I have had to introduce many additional illustrations, 108 in number. VI PREFACE These have been kindly lent by the publishers of Biekham's Operative Surgery (an encyclopaedic work of a very high standard), Prof. Wilkie's book on Operative Surgery, Operative Surgery by Grey Turner, Callander's Surgical Anatomy, Jaime- son's Illustrations of Regional Anatomy, Nelson's Loose-leaf Surgery, Straub's Surgery of the Chest, Gask and Ross' Surgery of the sympathetic nervous system. Due acknowledgement has been made in the text for any use that has been made of these authorities but should there be an inadvertent omission, I hope it will be kindly overlooked. I desire to express my sense of appreciation of the help rendered by two of my younger colleagues of the Department of Surgery, Carmichael Medical College, Mr. Amiya Sen, M.B., F.R.C.S., has made various suggestions and looked through manuscripts and proof sheets. Mr. P. N. Ray, M.B., F.R.C.S., who is also connected with the Calcutta Medical College, rendered me assistance in the early stages of the book. One of my former House Surgeons Dr. K. M. Seal, M.Sc, M.B., has been good enough to help me in the labour of writing and arranging the press matter with my Publishers. I also take this opportunity to thank my publishers, Messrs. Butterworth & Co., for rendering me very valuable services in many ways. Indeed Mr. Judson's patience and courtesy has been of a character that only a hard pressed author can properly appreciate ; more particularly when authorship conflicts with the calls of practice. K. K. C. WOOD STREET, CALCUTTA, 3rd August, 1936. LIST OF ILLUSTRATIONS. FIG. PAGE. 1. Dinner Knife method of holding knife 2 2. Penholder method of holding knife 2 3. Violin bow method of holding knife 2 4. Interrupted suture 6 5. Continuous suture 7 6. Continuous blanket suture 7 7. Manner of placing the subcuticular suture 8 8. Tension suture 9 9. Granny-knot 10 10. Reef-knot 10 11. Surgeon's Knot 11 12. Staffordshire Knot 12 12A. Clove Hitch 14 13. .Surface markings of the arteries of the upper extremities 16 14. Ligation of the subclavian artery (Right) Plate Facing 17 15. Ligation of the axillary and brachial arteries 19 16. Ligation of the brachial artery at the elbow 21 17. Incisions for ligating right radial and ulnar arteries, and superficial and deep palmar arches 23 18. Ligation of the radial artery Plate Facing 24 19. Ligation of the ulnar artery Plate Facing 24 20. Points of trephining for haemorrhage from the middle meningeal artery .. Plate Facing 25 21. Surface markings of the middle meningeal artery 26 22. Anatomy of the head and neck Plate Facing 28 23. Ligation of the common carotid artery Plate Facing 29 23A. Incisions for ligation of chief arteries of head and neck 29 23B. Superficial arteries of the neck Plate Facing 30 24. Triangles of the neck .. Plate Facing 31 24A. Blood supply of the faucial tonsil Plate Facing 33 25. Ligation of the lingual artery 34 26. Superficial arteries of the face Plate Facing 35 27. Course and distribution of the intercostal arteries Plate Facing 38 28. Structures on posterior wall of abdomen Plate Facing 40 29. Incisions for ligations of vessels in the abdomino- pelvic region 42 30. Incisions for ligations of vessesls about the buttock 44 31. Ligation of right internal pudic and sciatic arteries upon the buttock, below the pyriformis 45 XV111 LIST OF ILLUSTRATIONS FIG. PAGE. 32. Ligation of right gluteal artery upon the buttock, above the pyriformis .. .. .. 47 33. Ligation of the external iliac artery Plate Facing 48 34. Surface markings of the arteries of the lower extremity 51 35. Ligation of the femoral artery .. .. 53 36. Ligation of the popliteal artery Plate Facing 56 37. Surface marking of the anterior tibial artery . . 58 38. Ligation of the anterior tibial artery .. .. 59 39. Surface marking of the posterior tibial artery .. 62 40. Ligation of the posterior tibial artery .. .. 63 41-45. Methods of nerve-suturing .. .. . . 66 46. Nerve anastomois . . Plate Facing 66 47-50. Nerve grafting .. .. .. . . 67 51. Incisions for the exposure of supraorbital, infraorbital and mental nerves (surface anatomy) .. .. 68 52. Parotid gland and superficial nerves of the head Plate Facing 69 53. Injection of third division of the fifth nerve .. 70 54. Surgical approach to the phrenic nerve . . .. 72 55. Exposure of the great sciatic nerve at the lower border of the gluteus maximus Plate Facing 74 56. Wolff's method of uniting a tendon to the bone by implantation upon freshened bone and suture to adjacent periosteum . . .. .. 76 57-60. Tenorrhaphy . . .. .. .. 77 61-64. Less usual forms of tendon lengthening .. 78 65-68. Tendon shortening by doublings of the freshened tendon upon itself, followed by suturing .. 79 69. Tendon grafting .. . . .. .. 80 70. Incision for ligature of the upper part of the popliteal artery and the posterior tibial artery, and incisions for tenotomy of tibialis posticus and tendo achillis . . .. .. .. 82 71. Myorrhaphy .. .. .. ..87 72. Muscle lengthening by multiple cone method .. 88 73. Muscle lengthening by inverted V-shaped section .. 89 74. Manner of manipulating the long amputating knife in dividing the soft parts upon the far side of the limb .. .. .. ..93 75. Manner of manipulating the long amputating knife in dividing the soft parts upon the near side of the limb .. .. .. ..94 76. Circular amputation .. .. .. 95 77. Incising skin and fascia in flap amputation .. 95 77A-78A. Modified circular amputation .. .. 96 79. Amputation : flap method .. .. .. 97 80, Amputation : Racket method .. .. 99 LIST OF ILLUSTRATIONS XIX FIG. PAGE. 81. Technic of the ostéoplastie method of amputating—I 100 82. Technic of the ostéoplastie method of amputating—II 101 83. Wilm's tendino-plastic method of amputation . . 102 84. Thomas' forceps-tourniquet for controlling haemorrhage during operations upon the extremities .. 104 85. Amputation of the whole finger by disarticulation through the metacarpophalangeal joint .. 108 86. Disarticulation at elbow .. .. ..117 87. Disarticulation of the shoulder joint .. .. 122 88. Amputation of the great toe by disarticulation through the metatarsophalangeal joint .. .. 128 89. Lisfranc's amputation .. .. .. 133 90. Incisions for Chopart's amputation .. . . 135 91. Separating the os calcis from the astragalus in Farabeuf's sub-astragaloid disarticulation .. 136 92. Dorsal and plantar incisions in Syme's amputation of the foot at the ankle-joint .. .. 138 93. Formation of the heel-flap in Syme's amputation at the left ankle .. .. . . 139 94. Guyon's supra-malleolar amputation of the leg .. 143 95. Method of sawing the tibia .. .. .. 147 96. Method of sawing the bones of the leg . . .. 147 97. Incision for Stephen Smith's disarticulation at the knee-joint .. .. .. .. 151 98. Disarticulation at the knee-joint by Stephen Smith's method .. .. .. .. 152 99. Stump left after Stephen Smith's disarticulation at the knee-joint .. .. .. . . 153 100. Arthrotomy of the knee-joint . . . . 163 101. Excision of the upper jaw .. .. .. 168 102. Excision of the lower jaw . . .. . . 170 103. Resection of ribs .. .. . . 173 104. Linear osteotomy . . . . .. 176 105. Cuneiform osteotomy .. .. .. 177 106. Barker's method of suturing fractured patella .. 180 107. Stimson's method of suturing fractured patella .. 181 108. Suturing the fractured patella .. .. 182 109. Arthrodesis .. .. .. ..185 110&111. Author's modification of continuous irrigation by capillary drainage . . .. .. 186 112. The tendons concerned in excision of the wrist . . 189 113. Excision of the wrist-joint .. . . .. 190 114. Excision of the elbow-joint by posterior median incision—I .. . . .. .. 192 115. Excision of the elbow-joint by posterior median incision—II .. .. .. .. 193 116-118. Excisions of the shoulder-joint Plate Facing 195 XX LIST OF ILLUSTRATIONS FIG. PAGE. 119. Excision of the ankle-joint by a transversely curved external incision — Kocher's operation .. 197 120. Excision of the knee-joint .. .. . . 198 121. Excision of the knee-joint by an anterior transversely curved incision . . .. . . 199 121A. Operations in the middle line of the neck (surgical anatomy) .. .. .. . . 203 122. Incisions for opening the pharyngo-laryngo-trachéal tract and adjacent anatomic structures .. 204 123. Infrahyoid pharyngotomy .. .. .. 208 124. Position of the patient in laryngotomy and tracheo- tomy operations .. .. .. 209 125. Laryngotomy—Transverse intercrico-thyreotomy .. 210 126. High tracheotomy—I .. .. ..213 127. High tracheotomy—II .. .. .. 214 128. Tracheotomy tube in position . . .. 215 129. Low tracheotomy .. .. .. 216 130. Incisions generally used in operating for goitre .. 217 131. Thyreoidectomy for simple goitre, by the 'Collar' incision—I .. .. .. .. 218 132. Thyreoidectomy, for simple goitre, by the ' Collar ' incision—II .. .. .. .. 219 133. Diagram representing the midsagittal view of the brain stem, etc. .. .. .. 222 134. Relations of the middle meningeal artery with the cranium, insula and lateral ventricles .. .. 224 135. The Neisser-Pollack cerebral puncture points local- ized upon the Kocher craniometric lines .. 226 136. Wagner's ostéoplastie resection on skull, brain exposed .. .. .. .. 227 137. Cisterna puncture .. .. .. 230 138. Sauerbruch's para-vertebrate extrapleural thoraco- plasty incision .. .. .. 238 139. Stages of rib resection in Sauerbrucli's para-vertebral extrapleural thoracoplasty .. .. 239 140. Sauerbruch's para-vertebral extrapleural thoracoplasty Plate Facing 240 141. Closure of the wound and drainage .. .. 240 142. Points of election for pericardiocentesis .. .. 242 143. External cesophagotomy .. .. .. 244 144. Excision of the breast .. .. .. 247 145. Lembert sutures .. .. .. .. 256 146. Czerny-Lembert sutures .. .. .. 256 147-149. Intestinal anastomosis .. .. 258, 259 150. Anterior subphrenic abscess from perforation of an ulcer in the anterior wall of the stomach .. 264 LIST OF ILLUSTRATIONS XXI FIG. PAGE. 151. Posterior subphrenic abscess in the lesser sac of the peritoneum .. .. .. .. 265 152. Retro-peritoneal subphrenic abscess from a gastric ulcer adherent to the back of the lesser sac .. 266 153. Ssabanajew-Franck's method of gastrostomy—I .. 272 154. Ssabanajew-Franck's method of gastrostomy—II .. 273 155. Gastro-enterostomy—I .. .. .. 276 156. Gastro-enterostomy—II .. .. .. 277 157. Gastro-enterostomy—III .. .. .. 278 158. Gastro-enterostomy—IV .. .. .. 279 159. Gastro-enterostomy—V .. .. .. 280 160. Gastro-enterostomy—VI .. .. .. 280 161. Gastro-enterostomy—VII .. .. .. 281 162. Gastro-enterostomy—VIII .. .. .. 281 163. Gastro-enterostomy—IX .. .. ..282 164. Gastro-enterostomy—X .. .. .. 282 165. Gastro-enterostomy—XI .. .. .. 283 166. Suture of edges of mesocolon to stomach .. 283 167. Hernioplasty—I .. .. .286 168. Hernioplasty—II .. .. ..286 169. Hernioplasty—III .. .. ..286 170. Hernioplasty—IV .. .. ..291 171. Hernioplasty—V .. .. ..291 172. Hernioplasty—VI .. .. ..291 173. Hernioplasty—VII .. .. ..293 174. Hernioplasty—VIII .. .. ..293 175. Appendicectomy—I .. .. .. 301 176. Appendicectomy—II .. .. .. 301 177. Appendicectomy—III .. .. .. 303 178. Appendicectomy—IV .. .. .. 303 179. Appendicectomy—V .. .. .. 303 180. Appendicectomy—VI .. .. .. 303 181. Intussusception of the Enteric variety .. .. 310 182. Intussusception of the Ileocsecal variety .. .. 310 183. Intussusception of the Ileocolic variety .. .. 311 184. Intussusception of the Colic variety . . .. 312 185. Technic of treating irreducible intussusception .. 313 186. Suturing of the longitudinal defect in the bowel wall 314 187. Some of the more usual incisions for exposing the pancreas, spleen, etc. .. .. .. 322 188. Anorectal and peri-ano-rectal abscess in coronal section .. -. .. .. 329 189. Author's modification of Mitchell's operation for haemorrhoids .. .. .. .. 334 190. Abdomino-perineal excision of the rectum .. 339 191. The Broedel triangular subcapsular kidney fixation sutures .. .. .. .. 344 XX11 LIST OF ILLUSTRATIONS FIG. PAGE. 192. End-to-side anastomosis of the ureter .. .. 347 193. Ureterocolostomy—I .. .. ..348 194. Ureterocolostmy—II .. .. ..349 195. Amputation of the penis—I .. .. .. 373 196. Amputation of the penis—II.. .. .. 373 197. Plication and overlapping of the hydrocele sac—I .. 378 198. Plication and overlapping of the hydrocele sac—II .. 378 199. Plication and overlapping of the hydrocele sac—III .. 378 200. Spark gap tvpe electro-surgical units .. .. 382 201-272. Appendix (Figures of instruments) .. 409-422

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