The practice of surgery / by James Gregory Mumford ... with 682 illustrations.

  • James Gregory Mumford
Date:
1910
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery / by James Gregory Mumford ... with 682 illustrations. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    arterial circulation again has become vigorous, a secondary oozing into the stump is common. The leg should be tlressed in an abundant ab- sorbent dressing, reaching well above the knee, and the whole liiiih should be carefully immoljilizcd ui^on a comfortable s])lint. Many surgeons prefer the Teale metiiod of aminitation. The Teale method is that of providing a long anterior flap. The resulting stump is seemly and useful, while the operation is somewhat easier than that I have just described. Amputations through the middle of the calf are perfoi-med on much the same plan, for the arrangement of the parts does not differ materially from their arrangement in the lower third of the leg. When we come to amputations in the upper third of the leg, or im- mediately below the knee, we have to consider the possibility of adapt- ing the short stump to an artificial leg. Many surgeons believe that we should never make a tibial stump less than four inches long, but that the surgeon should perform his amputation by disarticulating the knee-joint, or by amputating above the femoral condyles. I have Fig. 67.5.—Teale's amputation. fovmd, however, that a short tibial stump, which is often troublesome on account of the back pull of the hamstring muscles, can be made useful if we perform a tenotomy on the hamstrings. Many surgeons still amputate through the knee-joint. At the Massachusetts General Hospital we rarely ])erform this operation, as we are convinced that amputation above the condyles of the femur gives the patient a more useful stump. Should the surgeon think it wise, however, to perform knee-joint disarticulation, he may well follow the commonly adopted bilateral method of Stephen Smith. Begin the incision one inch below the tubercle of the tibia, and carry it downward and foi-ward around the side of the leg and so up into the popliteal space, making a lateral flap. Duplicate this flap on the other side. Separate the soft parts from the bone; divide the joint ligaments and remove the leg with the patella. Some observers maintain that this disarticulation causes less shock than does a regular amputation. Be that as it nux}', we secure a far better stump by supracondyloid amputation.