THE
Indian swfsrr nmrns -of
Medicine, Surgery, Obstetrics, Jurisprudence, and the Collateral Sciences; %\xij jof (Sciural IJIcbixal JnMIijgcitte, Jhibiaix uiitr Europenn. [Edited by
VolnKoTim' I
C. Macnamara and K.
CALCUTTA, WEDNESDAY, JANUARY 1, 1873. of tho
ORIGINAL COMMUNICATIONS.
about
By
C.
Macnamaiia,
to the Native
Hospital, and to Hospital, Calcutta.
the
Ophthalmic
then the resulting cicatricial tissue, especially penis, frequently takes on an unhealthy action ; form, which worry the patient for months, and it may
and tho
ulcers
even
be all his life. that I
was
It
was
led some
from considerations such
time
testes, after the removal of
as
these the
attempt covering scrotal tumour, with healthy
ago a
to
wards more
step is to cut down on the testicles, which are to bo dissected out, and reflected back with the penis over the abdomen ; the mass
tedious; it often takes four or five months before the wound left after the removal of one of these scrotal tumours thoroughly
heals,
perinseum; this incision is carried first along the right, along the left side of the tumour, and the flaps, three fingers broad on either side, are dissected backtowards the thighs. It may be necessary to tie one or vessels during this stage of the operation. The next
of the abnormal
growth
is then to be removed
by cutting
the neck of the tumour, the flaps of skin on either side of its base being kept out of the way of the knife. The vessels having been tied with catgut ligatures, the testicles
through
The operation for tho removal of a scrotal tumour is simple enough, but, as every surgeon who has had much practice in Bengal knows, the subsequent treatment of these cases is most
near
{SXs'sfe"ly' ^ 18
and then
THE OPERATION" FOR THE REMOVAL OP SCROTAL TUMOURS (ELEPHANTIASIS SCROTI).
Surgeon
McLcod^]
skin ; and naturally attempted in the first instance to dissect off flaps of integuments from the inner and upper parts of the patient's thighs, and, turning those flaps backwards over the testes, to unite them by means of sutures, in a line corresponding to the raphe of the scrotum. After a little practice,
however, I found that, in some instances, a more simple proceeding than that a'oovo described might bo resorted to in cases of elephantiasis scroti; for, as a general rule, the iutegument corresponding to tho neck of tho tumour is healthy, and may be mado to form a very good covering for tho testicles. Having now operated on twelve patients witli favourable results, it seems desirable to bring the subject to tho notico of the profession, in order that we may determine if the operation proposed will stand tho test of a more extensive trial; and if so, to what class of cases it is applicable. My object is much the samo, in tho operation for tho removal of a scrotal tumour, as it would be in an amputation of the breast for malignant disease, simply taking away so much of the skin is involved in the disease, together with tho abnormal as growth, and then, if practicable, bringing the edges of the incisions together so as to get tho flaps to unite as speedily as possible, in placo of leaving a large open wound to heal by granulation. Supposing the penis is involved in the scrotal tumour, it is to be dissected out in tho first instance, and carefully held back against the Avails of the abdomen by an assistant. I then divide tho integument, in a line parallel to, and from three to four inches from the baso of tho tumour, tho incision extending from tho root of the penii to tho mesial lino
are
to be
of skin
applied
to the surface of the wound, and the
flaps
then carefully brought together over them, and united iu the mesial line by moans of silver wire sutures. The penis is enveloped in a fold of oiled lint, and a pad of cotton wool is firmly secured over the newly formed covering for the are
testicles. In some cases, the catgut ligatures having been employed to secure the vessels, I have known the flaps of skin to unite in the mesinl line within fifteen days of the operation ; the cicatrix over the a
month,
penis of
takes time to form?probably period several of my patients hospital with a pendulous, healthydartos, and with a very serviceable
course
at the end of which
been discharged from looking scrotum, minils its penis. Of course, a more extended trial alone can determine the point as to whether hypertrophy of the integument left after this operation will, in well selected cases, recur; there must evidently be instances of the disease in which the proceeding I advocate cannot be applied, in consequence of the skin being involved to such an extent as to prevent our forming the requisite flaps; but so far as my present experience goes, the parts operated on have gradually improved, and in some instances have come to resemble very closely the normal condition of the genital organs. In instances of elephantiasis scroti in which the skin of the penis is not much involved, I am in the habit of preserving as much of tho healthy integument as possible; it is naturally a far better covering of the organ than cicatricial tissue would be, and the more skin we can keep, the sooner and more perfect will the recovery of the patient be. have
Indian swfsrr nmrns -of
Medicine, Surgery, Obstetrics, Jurisprudence, and the Collateral Sciences; %\xij jof (Sciural IJIcbixal JnMIijgcitte, Jhibiaix uiitr Europenn. [Edited by
VolnKoTim' I
C. Macnamara and K.
CALCUTTA, WEDNESDAY, JANUARY 1, 1873. of tho
ORIGINAL COMMUNICATIONS.
about
By
C.
Macnamaiia,
to the Native
Hospital, and to Hospital, Calcutta.
the
Ophthalmic
then the resulting cicatricial tissue, especially penis, frequently takes on an unhealthy action ; form, which worry the patient for months, and it may
and tho
ulcers
even
be all his life. that I
was
It
was
led some
from considerations such
time
testes, after the removal of
as
these the
attempt covering scrotal tumour, with healthy
ago a
to
wards more
step is to cut down on the testicles, which are to bo dissected out, and reflected back with the penis over the abdomen ; the mass
tedious; it often takes four or five months before the wound left after the removal of one of these scrotal tumours thoroughly
heals,
perinseum; this incision is carried first along the right, along the left side of the tumour, and the flaps, three fingers broad on either side, are dissected backtowards the thighs. It may be necessary to tie one or vessels during this stage of the operation. The next
of the abnormal
growth
is then to be removed
by cutting
the neck of the tumour, the flaps of skin on either side of its base being kept out of the way of the knife. The vessels having been tied with catgut ligatures, the testicles
through
The operation for tho removal of a scrotal tumour is simple enough, but, as every surgeon who has had much practice in Bengal knows, the subsequent treatment of these cases is most
near
{SXs'sfe"ly' ^ 18
and then
THE OPERATION" FOR THE REMOVAL OP SCROTAL TUMOURS (ELEPHANTIASIS SCROTI).
Surgeon
McLcod^]
skin ; and naturally attempted in the first instance to dissect off flaps of integuments from the inner and upper parts of the patient's thighs, and, turning those flaps backwards over the testes, to unite them by means of sutures, in a line corresponding to the raphe of the scrotum. After a little practice,
however, I found that, in some instances, a more simple proceeding than that a'oovo described might bo resorted to in cases of elephantiasis scroti; for, as a general rule, the iutegument corresponding to tho neck of tho tumour is healthy, and may be mado to form a very good covering for tho testicles. Having now operated on twelve patients witli favourable results, it seems desirable to bring the subject to tho notico of the profession, in order that we may determine if the operation proposed will stand tho test of a more extensive trial; and if so, to what class of cases it is applicable. My object is much the samo, in tho operation for tho removal of a scrotal tumour, as it would be in an amputation of the breast for malignant disease, simply taking away so much of the skin is involved in the disease, together with tho abnormal as growth, and then, if practicable, bringing the edges of the incisions together so as to get tho flaps to unite as speedily as possible, in placo of leaving a large open wound to heal by granulation. Supposing the penis is involved in the scrotal tumour, it is to be dissected out in tho first instance, and carefully held back against the Avails of the abdomen by an assistant. I then divide tho integument, in a line parallel to, and from three to four inches from the baso of tho tumour, tho incision extending from tho root of the penii to tho mesial lino
are
to be
of skin
applied
to the surface of the wound, and the
flaps
then carefully brought together over them, and united iu the mesial line by moans of silver wire sutures. The penis is enveloped in a fold of oiled lint, and a pad of cotton wool is firmly secured over the newly formed covering for the are
testicles. In some cases, the catgut ligatures having been employed to secure the vessels, I have known the flaps of skin to unite in the mesinl line within fifteen days of the operation ; the cicatrix over the a
month,
penis of
takes time to form?probably period several of my patients hospital with a pendulous, healthydartos, and with a very serviceable
course
at the end of which
been discharged from looking scrotum, minils its penis. Of course, a more extended trial alone can determine the point as to whether hypertrophy of the integument left after this operation will, in well selected cases, recur; there must evidently be instances of the disease in which the proceeding I advocate cannot be applied, in consequence of the skin being involved to such an extent as to prevent our forming the requisite flaps; but so far as my present experience goes, the parts operated on have gradually improved, and in some instances have come to resemble very closely the normal condition of the genital organs. In instances of elephantiasis scroti in which the skin of the penis is not much involved, I am in the habit of preserving as much of tho healthy integument as possible; it is naturally a far better covering of the organ than cicatricial tissue would be, and the more skin we can keep, the sooner and more perfect will the recovery of the patient be. have
