The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen ; edited by John H. Brinton.

  • John Eric Erichsen
Date:
1854
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen ; edited by John H. Brinton. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    parts. The first incision should be made at a distance below the point at which it is proposed to saw the bone, equal to one-half of the diameter of the limb at that point, and should extend down to the muscular aponeurosis, cutting through the skin and superficial fascia; these are now to be loosened from their attachments, and reflected upwards like the sleeve of a coat; and being held in this position by an assistant, the second circular incision through the entire muscular mass is effected. The superficial layer of muscles having less firm attachment than the deep, retract more; consequently, to avoid a ragged, pro- jecting stump, a third circular incision is made through the deep muscles down to the bone, at the line of retraction of the superficial layer, and still further to avoid undue protrusion of the shaft, those fibres of the muscles arising immediately from it may be divided according to the plan of Bell. The parts are then strongly retracted, and the bone sawn through. The indications of the operation will be thus fulfilled : a hollow cone being formed, in which we have muscle enough left to cover the bone, and skin enough to cover the muscle. Should the amputation have been performed in the forearm or leg, the inter- osseous muscular mass must be divided as in the corresponding flap operations. In Fig. 10 the circular amputation is represented, the terraced arrangement of the wound in the amputated part is shown. Fig. 11 illustrates the corresponding conical stump.—Ed.] Fipr. 10. Fiff.ll. After the limb has been removed, the ligature should be applied. The main and larger arteries must first be tied. For this purpose, I think, fine compressed whipcord is the best material. The ends of these ligatures knotted together must be left long, so that they may be distinguished. Usually from two to four or six smaller vessels require to be tied, and they should be secured with ordi- nary ligature thread; but sometimes, when extensive suppurative action has been going on in the limb, the stump is excessively vascular, and a very large number of ligatures may be required. I have more than once had occasion to apply between twenty and thirty ligatures to vessels in the thigh under these cir- cumstances. As union always takes place by granulation in such qases as these, it signifies little how many are put on, the smaller ones separating early. Sutures must then be introduced through the edges of the wound, but may be left loose; and wet lint applied between the surfaces and over the outside, the dressing of the wound being deferred for a few hours until the surfaces are glazed. At least this is the plan, introduced by Mr. Liston, that I think should be generally fol-
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