A manual of surgery for students and practitioners / by William Rose and Albert Carless.

  • William Rose
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: A manual of surgery for students and practitioners / by William Rose and Albert Carless. Source: Wellcome Collection.

    1134/1172 (page 1128)
    Amputation through the Forearm is usually conducted by means of a flap operation, the flaps being either equal in length or one a little longer than the other. The muscles are divided circularly, and the bones should be thoroughly cleared before dividing them. Disarticulation at the Elbow-Joint is an operation very rarely seen, and is either undertaken by the elliptical method or with a large anterior flap. Amputation of the Arm may be carried out by any of the methods described, e.g., the flap, circular, or modified flap and circular, the choice in any par- ticular instance being determined by the requirements of the case. The circular amputation gives perhaps as good results as any. Disarticulation at the Shoulder-Joint.—Three chief methods are practised for the performance of this operation, viz., Spence's and Larrey's, or that by means of an external or deltoid flap. In all, the third part of the subclavian artery is best controlled by digital compression, the surgeon endeavouring to leave the division of the main vessels until the last stage of the proceedings. (a) Spence's operation (Fig. 382).—A preliminary incision similar to that for excision of the shoulder is first made, extending downwards and outwards through the fibres of the deltoid, from a point midway between the coracoid Fig. 381.—Amputation of Wrist Fig. 382.—Spence's Amputation at the by Dubreuil's Method. (Till- Shoulder by Anterior Racquet, manns.) (Treves' ' Operative Surgery.') and acromion processes. This passes directly down the bone, and, if necessary, the joint is at once opened and examined prior to any further steps being taken. The surgeon, standing on the outer side of the limb, then carries his knife from the lower part of the incision downwards and inwards across the axillary folds around the limb to the point from which it first started, thus making the incision racquet-shaped. The soft structures on the outer side of the vertical incision are separated from the bone, and then the outer half of the capsule, the muscles inserted into the greater tuberosity of the humerus, and the long tendon of the biceps, are divided. The parts on the inner side of the joint, including the subscapularis and front of the capsule, are dealt with in a similar way, but the main vessels and nerves are left intact for a time. By retracting the external flap and protruding the head of the bone from its socket, the remainder of the capsule can be severed, and then the knife, travelling down- wards between the humerus and the axillary vessels, is made to cut its way out, thus completing the disarticulation, the vessels being divided as the last step in the proceeding. If the knife is kept close to the bone, the trunk of the posterior circumflex artery is not interfered with. (6) Larrey's operation (Fig. 383) is very similar to the above, except that the vertical incision is made on the outer aspect of the joint, reaching downwards