Operation for the Radical Cure of Hydrocele and Inguinal Hernia

1891 Boston Medical and Surgical Journal  
The method of skin grafting as described by Thiersch is so well known and of such recognized value, that a description of its great possibilities, and the accepted details of the operation, need no new description. I wish only to call attention to two practical points that I think are new and which make the operation much more simple and accurate. With practice and care thin strips of the skin may be taken from the thigh by the ordinary amputating knife. As a rule, such strips are ragged at the
more » ... edges, and much of the graft is wasted, as the surface to be repaired must be entirely covered. I have had made by Codman & Shurtleff, (Boston), the instrument here figured. It consists of a feuestrated, curved plate, of which Fig. 1 represents the under surface and Fig. 2 the cross-section. This has sharp needle points as shown, which serve to keep it in place on the skin of the thigh, which, being stretched before the plate is applied, is kept so while the graft is being cut. This plate being applied to the thigh, the roller (Fig. 3 ) is pressed firmly down upon it, thus flattening the skin between the thin edges of the plate, and the knife (Fig. 4 ) being carried at a suitable distance behind the roller, cuts a graft, thin and of uniform thickness. The knife should be used like a saw, with short, sharp strokes. Care must be taken that the knife blade is carried as nearly parallel with the plate as possible, otherwise the edge is turned or nicked and the plate damaged. The plate should be made of hardened steel, not brass, otherwise it becomes rough and the knife is spoiled every time it is used. The blade of the knife should be very sharp, thin and well tempered. In cutting the graft let the knife pass under it, leaving it on the surface from which it was taken. The method of applying the graft so cut is the second point where I have a suggestion to offer. A few thicknesses of soft tissue paper (toilet paper is as good as any), properly sterilized and wet with warm salt solution is laid on the graft, and the paper and graft lifted together. The edges of the graft may bo straightened out with a few strokes of a probe and applied in the proper place, skin down. The paper is then removed, leaving the graft in place with no curled edges. Milan, directed by Paiiacheri, show ÖG2 cases of genu valgum. The genu valgum double is inueli more frequent in children than unilateral in the first years of life. It is treated by apparatus, wood or steel on young children, if the deformity is not very pronounced. Forcible correction was made three hundred and eighty-one times in two hundred and seventeen patients. The method of Tillaux was employed, and there was never any articular reaction or tearing of the internal tissue. In six cases a relapse was noted, and in six a paralysis of the external popliteal nerve, attributed by the writer to a compression of the apparatus. In cases eighteen years old it was corrected by osteotomy. Sixteen osteotomies have been done in ten cases. All have been followed by cure. CURVED OSTEOTOMY IN ANCHYLOSIS OK THE KNEE.18 The writer reports a case of osteotomy of the femur just above the condyle, in a case of long-continued anchylosis at the knee-joint. Transverse incision was made ; the tibia was separated, and, by means of a chisel, the femur divided transversely with a somewhat curved section jtiBt above the lino of articulation. The section was made so near to the point of articula-
doi:10.1056/nejm189112311252707 fatcat:ptdbgw2pzbfyhfhvou3ofsevi4