Volume 1

A dictionary of practical surgery / [Samuel Cooper].

  • Samuel Cooper
Date:
1825
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery / [Samuel Cooper]. Source: Wellcome Collection.

    100/1282 (page 88)
    patella, and, if the disease or injury will not ad- mit of the operation being done thus low, of re-. moving the limb above the knee joint. . In the Egyptian eampaign, however, Baron Larrey per-. formed two amputations very near the knee joint, almost on a level with the head of the fibula, which he judged proper to extirpate. The suc- cessful result of these operations dispelled the fear, which this experienced surgeon previously entertained about amputating in the. thick part of the upper head of the tibia; for, no caries of this spongy portion of the bone, no bad effects on the knee-joint, and no anchylosis of the stump ensued ; and, with the difference of a few days, the wound healed as readily, as that made in the.common below the tuberosity of the .tibia.. Since the above mentioned campaign, Larrey has adopted this practice in many cases, where it was impos- sible to have operated at the usual place, and he assures us, the success fully equalled what attends operations done at the ordinary distance from the knee. In 1806, another French military surgeon, who had tried this method himself, pub- lished a dissertation, in which he commended higher than the point allowed. by generally re- ceived rules. Garrigues, in forbidding amputation higher than the level of the tuberosity of the tibia, the thick. portion of which may be sawn, but not above the insertion of the tendon of the patella. verse line, drawn from this point, usually passes dvles of the tibia; but, as the relative positions of the heads of the two bones to each other differ the tuberosity of the tibia the point, above which the bone should never be sawn. By cutting higher, insertion; the bursa mucosa, situated underneath it, is wounded; and the Jigaments at the sides of the joint are injured; whence arise retraction of the patella, effusion of the synovia, and such dis- ease of the knee joint, as may render another am-. putation indispensable. By making the division on a level with the tuberosity of the tibia, the’ attachment of the ligament of the patella is pre- served, as well as that of the flexor tendons of the leg, which are requisite for the motion of the stump. The bursa mucosa is left untouched ;: and the head of the bone is sawn low enough to avoid creating a risk of caries. But, says Larrey,: if this mode of amputating below the knee be compared with amputation ‘of the thigh, as re- commended by authors for the cases in which the new method is proposed, the advantages of the latter are considerable. In thé.first place, life is less endangered, because a smaller portion of the body is removed. The operation is as easy in one situation as the other. The stumps heal with equal facility. Larrey has never seen the spongy part of the tibia become carious, nor per- ceptibly exfoliate. When the remaining portion of the fibula is yery short, as usually happens, it ought to be taken away, as it is an useless body,. inconvenient for the employment of a wooden leg. Larrey directs as much skin as possible to be preserved, and making a perpendicular incision,’ through that part of it, which covers-the tibia, in- order to hinder the bone from the patient has a firm point of support,.on which he can securely walk withouta stick. The stump: admits also of an artificial leg of the natural shape being worn, the kitee being always bent, provided the length: of the stump do not exceed the dia- meter ofthe calf of the artificial limb. (Mém. de” Chir. militaire, T. 3. p. 386—394.) From a passage, quoted by Mr. Guthrie, it would seem,. that Mr. Bromfield, (Chir. Obs: &c. Cases, vole 1. p, 185.) advised amputating as near to the knee as could be done, without risk of cutting the ligament. of the patella,: so’ that the stump: might not extend beyond the wooden leg. . On the whole, Mr. Guthrie’s own observations are acknowledges his belief, that “it would not suc-' ceed when indiscriminately done in the hospitals: of large cities,’’ though it may frequently be practised in the army with advantage, provided: the surgeon saw through the tibia below its tu-' berosity.. (Ox Gunshot Wounds, p. 223, and 227.) Upon looking over the details of the cases recorded by Larrey in confirmation of the above statement, I was struck with one important fact,: which does not justify a part of his commenda- quickly was. not well before the sixty-eighth day. (See Mém. de Chir. Mil. T. 3, p. 57, 397, 398, &c.) Hence, unless it be supposed, - that the wounds produced by amputation below the knee in the ordinary manner, are generally thus long in healing, as treated by the French the method so highly commended by Larrey, though. I am far from wishing to assert that, even if the stumps cannot usually be healed in less- time, more than a full compensation for this dis- advantage is not obtained by some of the benefits above enumerated. However, in order to be able: to pronounce any positive judgment on the merits of this mode of operating, it would be requisite not only to. see two or three’ successful cases: just after.their cure, but to examine the-state of a tolerable number of stumps, some time after they had been subjected to the pressure of an artificial leg. shed AMPUTATION OF THE ARM. that of the’thigh: like the latter it contains only one bone, round which the muscles are arranged. chii, while the more superficial ones extend along” the limb, without being at all adherent. The first consist of the brachialis internas, and ther the biceps, and long head of the triceps. Hence,: as in the thigh, unless when we are necessitated to amputate. very. high up, above the insertion of: the deltoid muscle. made more obliquely upwards than in the thigh,’ means two inches of muscle may be saved, be-, | | |