AMPUTATION AT THE HIP JOINT

1828 The Lancet  
has recently performed many experiments, from which it appears, that not only the division of the fifth pair is followed by morbid changes of the eye, but that the same effects take place after wounds of the neck. From eighteen experiments on dogs, horses, and pigeons, he comes to the following result: 1. The division of the cervical portion of the sympathetic nerve was sometimes made without any effect on the nutrition of the eye ; in other cases it was followed by redness and inflammation of
more » ... nd inflammation of the conjunctiva ; 2. The same morbid change, in most cases, followed the division of the pneumogastric nerve ; 3. The sympathetic and pneumogastric nerve having been divided, a very intense inflammation of the eye took place, which extended to its internal parts ; 4. If the carotid was tied, and at the same time the nerves in its neighbourhood were carefully avoided, the nutrition of the eye was in no manner influenced; 5. After a comprised the pneumogastric or sympatheligature of both carotids, the eyes suf-,fered more or less ; they became dim and opaque, but very seldom, a complete disorganisation ensued ; 6. But if the ligature tic nerve, an effusion took place from the anterior surface of the iris, the pupil was closed by a false membrane, and the cornea passed into suppuration. AMPUTATION AT THE HIP JOINT. On the 26th of April, M. Delpech reported to the Academie Royale de Med6cine, two cases in which he performed this operation. In one case, necrosis of the thigh-bone had given origin to numerous fistulous openings near the hip joint. From the extensive suppuration, the patient was in a hectic state, and it being ascertained that the joint was not diseased, the operation was decided upon. It was performed in the following manner :-An incision of two inches was made in the direction of the crural arch, by which the aponeurosis of the abdominal muscles, and the fallopian ligament, were laid open ; the fascia lata femoris was then divided, and the craral artery tied. M. Delpech now fixed the thigh-bone, and towards the middle of its neck plunged in a long single-edged knife, the point of which was then carried round the internal and posterior surface of the bone; the knife was then steadily drawn downwards and inwards, and brought through the integuments one-third down. In this manner a flap was formed, conaistiffg of the rectus internus, sartorius, pectineus, and the three adductor muscles; in Jts lower portion, it contained also the semiten sus and semimembranosus; in its upper part, the common tendon of the psoas and iliacus. The crural artery and vein were divided in the middle of the flap ; the hæmorrhage was so violent, that the artery was tied here a second time. The thigh wasnow kept in a:. duction, and the flap held by an assistant. M. Delpech then made a semicircular incision, by which the joint was laid open, and the tapsule was now easily divided. The thigh-bone being' now brought into its natural position, a semicircular incision was made through the obdurator internus, the three glutaei muscles, the pyramidalis, quadratus, the two gemelli, and, lastly, through the exter. nal part of the capsule. This section united the posterior extremity of the internal inci. sion with its anterior end, and had onlv a very slight inclination downwards. Besides the crural artery, not more than three ves. sels were tied, two branches of the arteria profunda, and the gluteal artery. The great-flap was now brought over the artlcn' lation, and, by some sutures and a bandage, kept in this position. No bad symptom followed the operation, and a cicatrix was formed within thirty days. The individual, who during the last four years has been in good health, was exhibited to the Society: the cicatrix was found completely solid and moveable, and only a very small fistulous I opening was discovered, which appeared to communicate with the cavity of the joint. After the report, M. Delpech made some additional remarks on the difficulty he had had in bringing the flap over the articulation, on the disadvantage of making the external flap too large, and on the necessity of immediate reunion. According to hmi, the success of the operation depends on the following conditions :—1. The disease, on account of which it is performed, must be of long standing ; 2. The operator must begin with tying the crural artery; S. One flap only must be made of the internal and posterior muscles of the thigh ; if two flaps were made, one of the external, and the other of the internal muscles, the colytoid cavity could not be so well covered, and inflammation and suppuration would then more easily take place; 4. The external section must be made parallel with the great trochanter, and the skin still higher, otherwise the internal flap would not perfectly correspond to the external wound, which it is intended to cover. In the second case, the operation was performed on account of extensive suppu. ration, in consequence of a compound fra-. ture of the upper part of the thielh.bune. The patient laboured under a chronic infiam.
doi:10.1016/s0140-6736(01)52801-9 fatcat:rc2zh2kchvcnjcwyoykckm2pym