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

470 Pages·1936·17.55 MB·English

by  Karuna K. Chatterji (Eds.)

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
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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