A manual of operative surgery . ius and rectus on the inside,until it reaches the neck of the femur.This incision does not divide any musclefibres or vessels or nerves of the slightestimportance. It is unnecessary to carrythe deeper part of the incision to thefull extent of the external wound. If anabscess is opened up before the jointis reached, its contents are thoroughlyflushed out with sterilised hot water, at a temperature of between 1050 and no0, before anythingfurther is done. Mr. Barkers well-known flushing-gouge may beused for the purpose—though an ordinary strong Volkmannsscoop will
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A manual of operative surgery . ius and rectus on the inside, until it reaches the neck of the femur.This incision does not divide any musclefibres or vessels or nerves of the slightestimportance. It is unnecessary to carrythe deeper part of the incision to thefull extent of the external wound. If anabscess is opened up before the jointis reached, its contents are thoroughlyflushed out with sterilised hot water, at a temperature of between 1050 and no0, before anythingfurther is done. Mr. Barkers well-known flushing-gouge may beused for the purpose—though an ordinary strong Volkmannsscoop will answer equally well. The abscess having been clearedout by means of the rush of hot water, the neck of the femur issawn across with a narrow saw in the direction of the externalwound. The diseased head can then be lifted out by means ofa sequestrum forceps, aided by an elevator. By the time thehead of the bone has been got out, the whole cavity iscomparatively clean. Now begins the search for further disease. This can usually. FIG. 488.—EXCISION OF THEHIP : LUCRES ANTERIORINCISION. 782 OPERATIONS ON BONES AND JOINTS [part vii be easily estimated by the left forefinger, with which the aceta-bulum is first examined, and then all the other parts of thejoint-cavity. Wherever diseased material is felt, it is cut awayby the flushing-gouge or scoop, the hot water carrying awaythe debris as fast as it is produced, and with it all blood, whileat the same time it arrests bleeding from the fresh-cut surfaces.When every part of the field of operation has been gouged andscraped clean of all tuberculous material, and the water runsaway clear, the cavity is dried out with sterilised sponges, oneor two of which are left in it until all the stitches are placed inposition. These should dip deeply and be placed close together.Just before they are tied the sponges are removed, and withthem the last traces of moisture. The anterior wound is perhapsnot well adapted for drainage, and if preferred