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Show 616 ornmrrox or rerun. INTEGUMENTS. set on here, we may pierce one half of the circle before the other, so as to injure the dura mater; and to avoid this, it re. qires the breaking up of the spine with considerable violence. 2. Over the frontal sinuses also, is an awkward place on which to perform trepan ; for if we carry on the perforation on the same level that we first apply it, we shall certainly cut the inner table, which forms the back part of the sinus, entirely through on one side of the circle, before the other part of it is touched. .51? large portions of diseased bone, a smaller suited to a child's skull; perforator ; brush ; lenticular raspatory ; trepan form ceps; a pair of small forceps, like those used by Dr. Blake for the teeth ; the saws of Mr. Hey; two or three elevators; and two with finer points than generally used, for picking out the loose pieces. The trephine should have double teeth, so as to make the cut wide, by which we are better able to ascertain our pron gross during the operation. There ought to be a relation be twixt the point of the elevators and the impression made by the trephine. An elevator with a reverted point will be found useful, both in picking out loose pieces, and in retain- ing a loose bone under the motions of the trephine. INTEGUMENTS. I'r/‘MH um" minimal" s - IN these days there is no scalping; that is to say, the sur- \. A, being the frontal sinus ; B, will pene trate into the brain l before C has touched the back part of the sinus. I would advise, that in operating upon the sinuses, we should apply, first, a large trephine, to perforate and break up the outer table, then a smaller one, whic h might be placed within this largercircle, perpendicularly upon the inner table. In operating behind the ear, we must also have recourse to anatomy, and recollect the inequalities of the bone in the in»! side. On the temporal process of the parietal bone , we must ex~ pect to hit upon the groove containing the grea t artery of the dura mater. We should avoid it, there fore, if another place of the bone be found convenient for the elevation of the depress sron. We have now-a-days no dread of oper ating above the venous sinuses. ' The Ixsrnunnx rs necessary are these-Th e common pock~ et case; a scalpel and probes ; tenaeulum; a quill; spongCS; lint; trephines of two sizes-one to enable us to take out geon does not cut out a circular piece of the scalp. He makes an incision upon the bone, and lays the flaps aside. Sometimes the way in which the integuments are cut by the accident will guide us how to make the incision; and we adapt our incision by making a triangular flap, or a semicircular cut, or raise and turn back the skin in the form of a T. But we ought to form the loose edge of our flap towards the ear, that matter may be the less liable to lodge, and that. it may gravitate towards the edge of the integuments: we should manage to' avoid acute angles, for they shrink. In making these incisions, the knife should not be held with a perpendicular edge, but somewhat obliquely, by which we avoid all danger of cutting upon a large rent in the skull, and penetrating it. Unless the patient be very weak, there will be no occasion to take up the artery. But at the same time, if we be cutting low upon the temple, the vessels may bleed too profusely, and require to be tied. WON! . Ml |