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sheath. The Zaditor Drops index finger is then inserted to the liottom of the wound, slid backward for a short distance Alaway Or Zaditor close to the muscular sheath and then hooked inward and forward away from the muscle, BABCOCK: OPERATION FOR VARICOSE VEIXS. when it at once catches the tWck resistant cord of the saphenous vein, which is lifted into the wound and at once clamped above by a hjemostat. This manceuvre enables the vein to be exposed within a few seconds even in an obese patient. The vein is Buy Zaditor now incised below the hsemostat, and the haemor- rhage at once controlled by entering the smaller bulb of the extractor into the lumen. The instru- ment is now carefully passed down the vein until it meets with an obstruction that cannot be overcome. The size and shape of the acorn tip of the instru- ment enables the extractor to slip through valves which would catch a smaller instrument. At times the instrument readily passes to the ankle ; again it is arrested in the middle or upper third of the leg. The upper end of the vein where it surrounds the sheath of the extractor is Generic Zaditor now isolated for a short distance and tied firmly to the shaft of the instru- Eye Drops Zaditor ment Purchase Zaditor by a strong silk ligature. This controls all oozing from the open vein. The vein is now ligated above and divided below the haemostat, and the stump dropped. The lower end of the instrument is now located. A half inch incision on the bulb ex- poses the vessel, the vein is separated from surround- ing tissues for a short distance and clamped below ; the bulbous expansion of the extractor is exposed, grasped and firm downward traction made upon the instrument. This traction pulls the vein loose from its surroundings, tears off the venous branches an Fig. 2. — Author's vein extiactor. inch or more from the main trunk, and causes Buy Zaditor Online the wall of the vein to be massed or pleated in small compass just below the upper bulbous expansion of the instrument. In much less Zaditor Eye Drop time than the descrip- tion requires the extractor is pulled from the lower incision with a fusiform mass of vein closely packed against the upper bulb of the instrument. There is little chance Order Zaditor Online of any portion of the vein that encir- cles the instrument being left behind. As a rule the hasmorriiage from the tract of the excised vein is too slight to be considered. In any case it is satis- factorily controlled as by a pressure bandage. To avoid infection in certain cases where the lower incision has to be made in close proximity to an ulcerated surface we select an extractor of ap- propriate length, which is introduced and buried through the upper wound, the skin being sutured and protected by an occlusive dressing before the lower incision and extraction of the vein is at- tempted. If a bougie d boule is used the instrument is. of course, entered and the vein withdrawn through the .same incision, a second incision being made to divide the vein and fasten the distal end be- low the bulii of the bougie. It is obvious that the segment of vein removed caiuiot be longer than the shaft of the instrument, and with a bougie d boule there is also a tendency for the vein Order Zaditor to be turned inside out in the extraction. Although tiiis method by inversidii is simpler Buy Cheap Zaditor and more s.iiisfactorv than that by Mayn's nr Kellar's method there is a iiossi- bility of the wall of the vein parting under the Zaditor Cost trac- tinn. \Ve Zaditor Eye Drops therefore prefer the use of the special extractor. The instnnuent may bo i)assed from be- low upward instead of from above downward, the extraction being made through either the upper or lower wound as is more convenient. After removal of the main trunk of the internal saphenous the pro- cedure may Purchase Zaditor Online be repeated upon any Cheap Zaditor remaining large veins. A transient throm.bosis of the remaining su- perficial veins about the ankle usually follows the operation. Along the tract of the excised vein there is usually but little secondary swelling or tenderness, although often some discoloration of the skin. As a rule the patient may be out of bed by the tenth day. Most striking is the effect upon very chronic vari- cose leg ulcers, which usually heal within a few weeks after the operation. If, however, the vari- cosity Zaditor Tablets Zaditor Coupons is not Zaditor Price lirrrited to a few large superficial trunks, but the skin shows a plexus of dilated veins and a tendency to Zaditor Coupon diffuse oedema, then the operation as descr-ibed above is often not sufficient ; the ulcers partially or completely heal, but show a tendency to break down again. In these cases the extirpation of the main venous trunks should be supplemented by an interrupted circumcision of the leg (Powell's method or Schede's operation), the incision being so planned as to divide the more vascular areas of skin. Dr. William A. Steel, who has been actively asso- ciated in the development of the method for ex- tracting veins, has carefully studied the after his- tory of many of our patients following operation, and has found that relapses are rare after the com-

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