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Being called upon recently to excise a portion of a rib, in a critical case of chronic empyema in which closure of the pus cavity, which I had previously freely opened, was prevented by inability of the chest wall to further retract, I took occasion to review the different methods in vogue for the performance of this operation.
The incision through the flesh is of course easy; nor is the peeling off of the periosteum difficult, but it is not so easy to cut through the bone and at the same time not injure the soft parts. The chain saw, the Hey saw and the trephine are the means usually employed to cut the bone, the soft parts being held aside meantime by retractors or by a strip of leather, pasteboard or flexible metal passed behind the rib. None of these methods, however, are free from objections, chief among which
BALDWIN JF. THE COSTATOME IN EXCISION OF THE RIB. JAMA. 1883;I(19):557–558. doi:10.1001/jama.1883.02390190009001c
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