In this
connection he proposes the following operative procedure: Two
longitudinal incisions to be made from the lower border of the 3d
rib to the upper border of the 7th rib, one running along the
inner margin of the sternum, the other about ten mm. inside the
nipple-line. These incisions are joined by a horizontal cut made
in the fourth intercostal space. The 4th, 5th, and 6th ribs and
cartilages are divided and the outer cutaneous flaps turned up;
pushing aside the pleura with the finger, expose the pericardium
and incise it longitudinally; suture the heart-wound by
interrupted sutures. Del Vecchio adds that Fischer has collected
records of 376 cases of wounds of the heart with a mortality two
to three minutes after the injury of 20 per cent. Death may occur
from a few seconds to nine months after the accident. Keen and Da
Costa quote Del Vecchio, and, in comment on his observations,
remark that death in cases of wound of the heart is due to
pressure of effused blood in the pericardial sac, and, because
this pressure is itself a cheek to further hemorrhage, there
seems, as far as hemorrhage is concerned, to be rather a question
whether operative interference may not be itself more harmful
than beneficial.
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