File:A new manual of surgery, civil and military (1917) (14766455632).jpg

Identifier: newmanualofsurge00ochs (find matches)
Title: A new manual of surgery, civil and military
Year: 1917 (1910s)
Authors: Ochsner, Albert J. (Albert John), 1858-1925 Percy, Nelson M. (Nelson Mortimer), b. 1875
Subjects: Surgery
Publisher: Chicago, Cleveland Press
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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de of the nail and underneath thenail. An incision is then made down through the nail and its matrix parallelto its long axis, on a line so that about one.fourth of the nail may be removed.This one-fourth of the nail, together with its matrix and the granulationtissue along the edge, is carefully dissected away. A wedge-shaped piece oftissue is removed at the base and just below the lower end of the nail, andthe defect closed with a few horse hair stitches. A rather firm, dry, sterile dressing should be applied before the rubbertourniquet is removed. The results from this operation are invariably good. BUNION Bunion is quite common but is usually looked upon as a very trivial affair,although the discomfort suffered by patients afflicted therewith is very great.The condition is usually associated with hallux valgus. Among the various causes the wearing of pointed, short and tight shoesis the most important. Rheumatic arthritis may be a contributing cause. SURGERY OF THE EXTREMITIES 733
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734 SURGERY OF THE EXTREMITIES j Patients with a long great toe seem more liable to develop a condition ofhallux valgus, Avitli the formation of a bunion, than those Avith a short greattoe. In cases of well-marked bunion there is a true bony enlargement on theinner side of the head of the metatarsal bone of the great toe, -which becomescovered with a bursal layer. In cases where the deformity is only slight, the wearing of properly fittedshoes will often relieve them, but in the more pronounced forms an opera-tion is the only method that attords relief. Operation. During the past few years we have used the method of placinga flap of the bursa down over the end of the resected metatarsal bone afier themethod of C. H. Mayo. A curved incision with its base downwards is made over the inner sideof the metatarso-phalangeal joint and a llap of skin is dissected loose-leavingthe bursa intact. A horse-shoe shaped incision is then made with its base onthe phalangeal side of the joint, loosening

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