Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . umatized, its blood supply should not be harmed, and the raw surfaceleft after the enucleation should be covered with fascia to protect it. The doable resection of nontoxic goiter, which is called for because of the VOL. II—25 386 SURGICAL TREATMENT mechanical inconvenience of the swelling, is an operation which should haveno mortality. The tumor is best exposed by the horizontal incision extend-ing from one external jugular vein to the other. The upper flap is di

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Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . umatized, its blood supply should not be harmed, and the raw surfaceleft after the enucleation should be covered with fascia to protect it. The doable resection of nontoxic goiter, which is called for because of the VOL. II—25 386 SURGICAL TREATMENT mechanical inconvenience of the swelling, is an operation which should haveno mortality. The tumor is best exposed by the horizontal incision extend-ing from one external jugular vein to the other. The upper flap is di
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Image ID: 2AJAG55
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . umatized, its blood supply should not be harmed, and the raw surfaceleft after the enucleation should be covered with fascia to protect it. The doable resection of nontoxic goiter, which is called for because of the VOL. II—25 386 SURGICAL TREATMENT mechanical inconvenience of the swelling, is an operation which should haveno mortality. The tumor is best exposed by the horizontal incision extend-ing from one external jugular vein to the other. The upper flap is dissectedup as far as the thyroid cartilage and the lower flap as far as the interclavic-ular notch. After separating the muscular structures by a median incisionthe thin capsular covering of the gland should be drawn aside. The finger,under this capsule, sweeps about the gland upon an exploratory tour.Some lateral veins may require ligation. The sternomastoid muscle on oneor the other sides may have to be divided. If the gland is found uniformlydiseased, colloidal, cystic or adenomatous in both lobes, both should beresected.. Fig. 1081.—Operation for Goiter. The tumor is lifted forward and freed from its posterior attachments. The superior and inferior thyroid vessels are seen ligated. (After Mayo.) After dissecting free the two lobes so that they are brought forward and lieupon the retracted muscles the isthmus should be divided between two forcepsin its narrowest part (Fig. 1083). The gland still has its posterior andvascular connections. Each side is then dissected away from the trachea.Complete removal of all gland tissue is not to be considered, but a resectionof part of each lobe should be proceeded with. A row of clamps is placedabout a lobe, catching the larger vessels which are exposed but especially forthe purpose of holding the stump. The part of the gland anterior to theseclamps is resected. This is done in such a manner as to leave a wedge-shapedexcavation in th

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