OCR Text |
Show 38 or THE NEEDLE. or THE NEEDLE. which has not been drawn sufficiently tight, sometimes remains a long time, because it does not entirely deaden the part, and a bud of granulation grows up, around the neck of which the ligature hangs loose. it draws the flesh in over the bleeding orifice. is done in this way: 39 The operation If a nerve be included in the liga« ture, great pain is felt at the time of drawing it; there are twitches in the wound during the cure ; and the ligature takes a tedious time to loosen. It, has happened that the nerve thus included in a ligature has enlarged into a bulbous end; and that, like a button in the noose of the ligature, it has detained it for months. To cut out a ligature which is thus remaining and keeping the wound unhealthy, you must soak and separate the two ends of the ligature down to the knot; then move the blades of the scissors along one of the ends until you are close upon the knot; and, after cutting it, by pulling gently on the remaining end, the knot will slip. The use of the needle any where else than on the face of a .~. ' < INUIA. ,u3.,;¢ez.‘~e--r-<. JbUW stump, requires an accurate knowledge of anatomy. The operator may otherwise transfix a large artery when he is taking up a small one, or include a nerve, so as to produce a contraction of the limb. When a great artery is wounded by a penetrating or oblique wound, the integiunents adhere by compression, and there slowly arises a beating tumour over the wound of the artery, under the fascia and skin, or even under the muscles. This sometimes happens where the tourniquet cannot be applied ; and in that case the surgeon is to open the tumour with a small (1.) Is the bleeding orifice. I introduce the curved needle at (2), and brinfr it out at (3), passing it through the cellular niemlniane. I introduce it again at (It), on the other side of the vessci, and bring it out at (5), some distance from (2) : then, by casting a knot on the ends of the ligature, I am ena- bled to draw the cellular membrane like the mouth of a purse, and to in :iude the bleeding artery. Either after an operation, or in a wound where there have. been many vessels tied, we should assert our ligatures; and if we have not twisted and tied the extremities of each ligature wound, and introducing his finger (before the blood escapes), he has to endeavour to feel the beating artery. Securing, by together when they w ere drawn, we should do it now, for the the pressure of the point of his finger, the bleeding; orifice, an assistant lays the whole tumour open, and clears the cavity of coagula: the surgeon then taking the needle, passes it round the vessel, and the assistant tics it. The needle is sometimes ther, the threads should be left hanning, if possible, in the depending part of the wound. - used in the face of a stump, or in an open wound, generally when the mouth of the artery cannot be distinctly seen. It either includes much of the muscular lcsh, or the cellular membrane, in the same knot with the mouth of the artery, 01' convenience of dressing. When the parts are brought toge- if we are anxious to procure adhesion, and there be so ma< ny and large ligaturcs, that if they were allowed to hang from the nound they would necessarily obstruct the union; then, by separating the threads of which the ligature is composed, we may cut short the greater part of it, so that only one strong thread remains hanging from the lips of the wound, which will yet be suflicicnt to pull away the ligature in due time. |