File:Diseases of the kidneys, ureters and bladder, with special reference to the diseases of women (1922) (14579314440).jpg

Identifier: diseasesofkidney01kell (find matches)
Title: Diseases of the kidneys, ureters and bladder, with special reference to the diseases of women
Year: 1922 (1920s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943 Brödel, Max, 1870-1941 Burnam, Curtis Field, 1877-
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Publisher: New York, London : D. Appleton and company

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latissimus dorsi is very well developed and verywide, there is an overlapping of the external oblique muscle, and in such casesit is necessary to cut through the fibers of the latissimus dorsi, which may bedone either transversely across the fibers of the muscle or by splitting of thefibers. In either case one retracts the incision so that the lumbar fascia comesinto view, as shown in Figure 246. The fascia here has a white, shiningappearance. Puncture of Fasci a.—With the muscles retracted on each side bythe assistant, a blunt clamp is pushed through this fascia. Immediately isseen the yellow subperitoneal fat, as excellently shown in Figure 246. The TREATMENT. 509 opening in this fascia after puncturing can be conveniently carried out byblunt stretching with tlie hngcrs (Fig. 24(1). (Vmsidcrable strength can beutilized here and very little benioiTliage is occasioned, ilie external edge ofthe quadratus lumborum muscle lies on the inner edge of this incision. By .M.latissimus, split
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Fig. 24G.—Typical Inxision for Suspension of Kidney. In tliis case a wide j\I. latissimusdorsi requires its being cut across transversely for a little distance. Superior lumbartriangle between M. quadratus and lateral muscles already opened. Perirenal fatgrasped with traction forceps. Kidney just visible. pulling up the fat and working down toward the kidney, the thin fibrous cap-sule of Gerota is brought into view (Fig. 246). This can be torn open withthe fingers, when the pale, soft, fluent, lemon-colored fat immediately surround-ing the kidney comes into view, easily recognizable by its color and consistency,in marked contrast to the subperitoneal fat. Dragging of Kidney into View.—In many cases the position ofthe patient on the bag has pushed the kidney back under the ribs, and in 510 MOVABLE KIDNEY. order to bring it into view a number of clamps can conveniently be appliedto the fatty capsnle (Fig. 247). It is necessary in doing this to have at leasthalf a dozen, as traction

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