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Show 64! The saphena vein is distended in all its length-it has lost the guard of its valves-the whole column of blood presses from the head and heart upon the veins of the leg I They become more and more distended, or rather permanently enlarged varicose tortuous, and hard in their coats ; and when the patient stands long, there is an insufferable pain in the leg and. ankle from their distension. It has happened that these veins have given way in some part, and the woman has almost instantly expired. Dreadful haemorrhagy has taken place in many instances. To remedy or prevent these evils, an operation is performed on this principle : that if we altogether obstruct the return of the blood by the trimlr of the cutaneous veins, the blood will find other channels, whose valves have their action, viz. by deep seated veins, which lying under parts not allowing of distension, retain the use of their valves, which relieves the limb from the oppressive column of blood. , _,.-2‘>Ja+:.le.~-.~.- 4. - f . ,2. "3"" "WM , - ornamron. INSTRU)IEN'1‘S.~--A scalpel ; forceps; common needle or an eyed probe. and blunt hook, at The assistant compresses the trunk of the vein, that the vein in the thigh may be distended : he then with his thumb draws the skin a little aside from the vein, that when the operation is finished the skin may be retracted and cover the vein. The surgeon now makes an incision in the course of the veinas, generally about the middle of the thigh : in length about two inches, or an inch and a half, according to the thickness of the fat. The vein appears covered with its bed of cellular membrane , which is to be nicely dissected by the side of the vein, so that the needle or eyed probe may be passed under the vein. OPERATION ON THE SAPHL‘NA VEIN. OPERATION ON THE SAPHEHA. VEIN. The ligature may be of the common size, such as you ‘ Not, however, directly on the vein, but a little to that side to which we nave drawn the integuments. This is to avoid cutting the vein; of whicll, b} the bye, there is little danger in dcxtcrous hands. 65 would use for the arteries of the stump in amputation of the thigh. Tie it firmlyvthere is no fear of the breaking of the coats of this vessel. The assistant now lets go the integuments which he hard pressed aside with his thumb, and they cover the vein so that the ligature comes out obliquely from the wound. A soft compress is applied above the ligature of the vein; and the leg and thigh is moderately bound by a general roller The patient is enjoined to keep the horizontal posture. The immediate eli‘ects of this operation are, that the swell» ing of the veins subsides; a slight pain is felt by the patient when we press in the course of the vein above the ligature. The distended veins of the legs and the varicose tumours, sometimes inflame a little; but, subsiding, they degenerate into hard knots and cords, and the blood forsakes them. This operation should not be performed when the patient has atoazing, though apparently trifling cough. For after the operation, I have felt the impulse given to the column of blood in the cave. by the action of the abdominal muscles and diaphragm strike strong upon the ligature ; and every occasion of inflammation must here be carefully avoided. This im‘ pulse may tear up the new adhesions; for the same reason, costiveness and violent straining of every kind Ought to be avoided. To prevent the progress of inflammation along the vein, and to guard the ligature and inflamed part of the vein from distension, I advise the application of a compress above that part of the vein which has been operated upon. It ought not to be concealed that patients have died after this operation, in consequence of inflammation of the vein, and irritative ever. In Guy's hospital I believe the operation is not performed. The operation is very often performed for ulcers of the leg. These ulcers, depending on a varicose state of the veins, are generally low on the leg, on the ankle, or foot. They have hard elevated edges, and are of a dark or brownish red colour. A dark red extends over the skin around the ulcer, and vari- "USC veins 31"? around the ulcer. V'C-T . l. K And upon the leg, the inte: «a. 2' ‘meh , manic» .. Mun" |