A manual of operative surgery . a rule thebest form for the incision is a somewhatsinuous one, like an elongated letter S,as shown in Fig. 349. This incisionallows of considerable lateral retractionand exposure of branches or tributaries ofthe vein over which it is placed. Atthe same time there is no more risk ofsloughing or imperfect healing of thewound than from a linear incision. Any-thing approaching a transverse cut shouldbe avoided, for there is no part of thebody in which the skin heals with moredifficulty than the leg in a patient whohas been long subject to varicose veins. The incisio

A manual of operative surgery . a rule thebest form for the incision is a somewhatsinuous one, like an elongated letter S,as shown in Fig. 349. This incisionallows of considerable lateral retractionand exposure of branches or tributaries ofthe vein over which it is placed. Atthe same time there is no more risk ofsloughing or imperfect healing of thewound than from a linear incision. Any-thing approaching a transverse cut shouldbe avoided, for there is no part of thebody in which the skin heals with moredifficulty than the leg in a patient whohas been long subject to varicose veins. The incisio Stock Photo
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The Reading Room / Alamy Stock Photo

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2AXFJEM

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925 x 2702 px | 7.8 x 22.9 cm | 3.1 x 9 inches | 300dpi

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A manual of operative surgery . a rule thebest form for the incision is a somewhatsinuous one, like an elongated letter S, as shown in Fig. 349. This incisionallows of considerable lateral retractionand exposure of branches or tributaries ofthe vein over which it is placed. Atthe same time there is no more risk ofsloughing or imperfect healing of thewound than from a linear incision. Any-thing approaching a transverse cut shouldbe avoided, for there is no part of thebody in which the skin heals with moredifficulty than the leg in a patient whohas been long subject to varicose veins. The incision is carried down to thepurple wall of the vein along its wholelength, but where it is necessary to remove a varix involving both leg and thigh, the incision should beinterrupted opposite the knee-joint. In fact, two or more in-cisions, each about three to five inches long, will as a rule givesufficient access, and a better ultimate result than a single verylong one. The somewhat tedious dissection of the vein and its branches. FIG. 348.—LIMITED VARI-COSITY OF VEIN OF LEG—VERY SUITABLE FOROPERATION. The lateral branches wouldhave to be ligatured aswell as the two ends ofthe main vein. 442 OPERATIONS ON VEINS [PART V will be much helped by the use of a very sharp scalpel, and bythe following detail. The vein being well exposed throughout theincision, one end of it is isolated and tied with catgut of mediumthickness. It is then held with Wells forceps and dividedbetween this and the ligature. The divided end being then drawnupon, a few touches of scalpel or blunt dissector will detachthe vein from its bed of connective tissue for a long distance, any branches being ligatured or caught with forceps before division. All chance of injury to the cuta-neous nerves which run close tothe veins is thus avoided. Finally, catgut ligatures are applied tothe other end of the vein, andto any clamped branches, thewound being lightly washed withsterile water and sewn up. Wehave tried many way

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