The Operations of Surgery; a Systematic Handbook for Practitioners, Students And Hospital Surgeons ..

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An ample longitudinal incision * will nearly always give all the room that is required, and such a scar will be little conspicuous, falling, as it does eventually, into the sulcus just internal to the sterno-mastoid, a point of much imj^ortance in women.
The skin and platysma being cut through, any superficial veins carefully tied, the deep ftiscia is slit up and the gland itself exposed, bluish-red and with large veins on its surface. Spread also over this are often one or more of the depresso
...rs of the hyoid bone; these are separated with a blunt dissector, or, if needful, divided between silk ligatures. One or more large retractors are now inserted so as to draw outwards the sterno-mastoid and large vessels, while the surgeon with his left index finger, or a blunt dissector, frees the enlarged part of the thyroid from its bed, shelling it forwards, and probably finds it only fixed above, below, and internally, by the thyroid vessels and the isthmus. In effecting this separation, the greatest care must be taken to work gently and to keep close to the tumor,t the veins being often much enlarged and thin-walled.J The upper extremity of the * Tlie incision can either be made as above, laterally, or it may be angular with a straight limb in the median line from hyoid to sternnni, and one passing obliquely outwards and upwards from the upper end of the first.

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