PIROGOVA SECTION

From Big Medical Encyclopedia

PIROGOVA SECTION ( N. I. Pirogov , the domestic surgeon and the anatomist, 1810 — 1881) — a section for extra peritoneal approach to an outside ileal artery for the purpose of its bandaging, developed by N. I. Pirogov and for the first time described in it «Surgical anatomy of arterial trunks and fastion». Not corresponding name «outside chrevosecheniye» (laparotomia externa) is appropriated to a section, however it is quite eurysynusic.

the Diagrammatic representation of a section of Pirogov (at the left below the black line showed the direction of a section of skin): 1 — a femoral nerve, 2 — an iliolumbar muscle, 3 — bottom edge of internal slanting and cross muscles of a stomach and a peritoneal bag, 4 — an outside ileal artery, 5 — an outside ileal vein, 6 — edges of a dissect aponeurosis of an outside oblique muscle of a stomach.

For production of a section first of all it is necessary to grope an inguinal sheaf. It easily works well at not corpulent person at strong extension of a hip in a hip joint; at stout persons it is necessary to be guided on an inguinal fold. The section of skin 8 — 9 cm long is conducted in parallel 1 — 2 cm above an inguinal sheaf and finish 4 — 5 cm above a pubic hillock of a pubic bone. The middle of the section which is carried out thus will correspond to a method of crossing of a wound an outside ileal artery. The last is projected on the line beginning from the middle of distance between an upper front ileal awn and a pubic symphysis and going towards a navel. The section gets through skin and hypodermic cellulose with a superficial fascia, baring an aponeurosis of an outside oblique muscle of a stomach. The vessels (a superficial epigastriß artery and a vein) lying in hypodermic cellulose cross between ligatures. The aponeurosis is cut on the course of fibers immediately over an inguinal sheaf. Edges of a wound part with blunt retractors; at the same time muscle fibers of bottom edge of internal slanting and cross muscles of a stomach are shown. They are stupidly allocated from a fillet of an inguinal sheaf and a hook delay a little up then the cross fascia of a stomach opens; it yellowish color, is hardly tense. The fascia is cut on a fluted probe; behind it friable preperitoneal cellulose and bottom edge of a peritoneal bag which is removed in the stupid way up is bared. In the depth of a wound determine by a finger the smooth inner edge of an iliolumbar muscle covered with an ileal fascia and on it — the pulsing outside ileal artery (fig). During the bandaging of an outside ileal artery it is necessary to delay the deep vein surrounding an ileal bone which passes immediately over an inguinal sheaf ahead from an artery and across it down. About 7 mm higher than an inguinal sheaf, and sometimes and below it, from the outer edge of an outside ileal artery the deep artery which is bending around an ileal bone, and departs from an inner edge — the lower epigastriß artery. It is necessary to impose a ligature on an outside ileal artery above (proksimalny) these two arteries.



Bibliography: Pirogoff N. I. Anatomia chirurgica truncorum arterialium atque fasciarum fibrosarum, Dorpati, 1838 (pyc. lane, SPb., 1881).


A. Sirotkin.

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