Читать книгу The Surgery of the Skull and Brain - Louis Bathe Rawling - Страница 27

All surgeons must have appreciated the difficulty attendant on the application of forceps to, and the ligature of, divided scalp-vessels. The patient may lose a considerable quantity of blood, and much valuable time will be wasted before the more essential part of the operation is commenced. All this can, under ordinary circumstances, be avoided by the use of the scalp-tourniquet. As used by Cushing it consists of a rubber ring fashioned after the style of an Esmarch’s tourniquet, encircling the head and passing from the lower frontal region in front, above the ears, to the lower occipital region behind. A median tape, passing from glabella to occiput, prevents any tendency for the tourniquet to slip down over the eyes, at the same time acting as a convenient landmark for the superior longitudinal sinus.

The tourniquet, when applied with the correct pressure, should, under ordinary circumstances, completely control all hæmorrhage from the divided scalp-vessels. It should be noted, however, that bleeding will be rather increased than otherwise if the tourniquet be so loosely applied as to impede the venous return without compressing the scalp arteries. A little experience will soon enable the operator to gauge the requisite pressure.