Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

    831/898 page 815
    by a circular sweep of the knife, and sawing the bone across slightly above the plane of the divided muscles. Special amputations.—Amputation at the shotdder-joiut may be performed either by the flap or by the oval method. In either case the subclavian artery should be compressed above the clavicle, or in some instances the axillary tied before the amputation is begun. The flap method.—A large flap consisting of integuments and deltoid muscle is usually taken from the outer aspect of the joint, either by transfixion or better by cutting from without inwards. In transfixion, the deltoid having been grasped and raised by the surgeon's left hand, the knife should be made to transfix the limb on its upper and outer aspect just below the acromion, and a flap formed with rounded angles about four inches long. The flajD is turned back, the head of the bone freed from its connec'ions, and the knife passed behind it, and made to cut its way out towards the axilla, the axillary artery being seized as it is divided. In cutting a flap from without inwards, the incision is made from a point just external to the coracoid process and carried in a circular sweep downwards as low as the insertion of the deltoid, and then upwards to the posterior fold of the axilla just behind and below the acromion. In the oval method [^pence's modification), an incision is made from just external to the coracoid vertically downwards as in excising the joint through the clavicular fibres of the deltoid and pectoralis major to the humeral attachment of the latter muscle, which is then divided. The incision is next carried with a gentle curve through the lower fibres of the deltoid towards the posterior border of the axilla. A second incision is then made through the skin and fat only, from the point where the straight incision terminated across the inside of the arm to meet the incision at the outer part. The outer flap is next dissected up with the trunk of the posterior circumflex artery, the head freed from its connections, disarticulated, and the remaining soft parts cut through on the axillary asj^ect, the axillary artery being divided last of all. Amputations of the arm and forearm are usually performed by double skin-flaps and circular division of the muscles. The circular method, however, or amputation by single or double transfixion or by Teale's method may be employed. A mputation at the wrist maj be performed by two short flaps, by a long palmar flap, or by an external flaj) taken from the thumb. In the double-flap method the incision is commenced half an inch ibove the styloid process of the radius or ulna. The flaps should be cut square, with rounded angles, and about two inches in length. The joint should be opened on the dorsal aspect, and on the coni- Dletion of the disarticulation the styloid processes of the radius and ilna sawn off.
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