A report of surgical cases treated in the Army of the United States from 1865 to 1871 / War Department, Surgeon General's Office.
- Date:
- 1871
Licence: Public Domain Mark
Credit: A report of surgical cases treated in the Army of the United States from 1865 to 1871 / War Department, Surgeon General's Office. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![lacerated. The soldier was removed to the field hospital of the brigade, located five hundred yards in rear of the line of battle, at which hospital, wry shortly after reception of injury, I performed amputation through tiic knee-joint. The steps of this operation were substantially those taken in the second case. The patient rallied well, and was carried to the rear very shortly. Since then I have not heard of him. Owing to the press of my duties at the time I could make no notes, and these statements are made froni memory, twenty months after the operation. The battery to which tills sergeant was attached was commanded by Captain Martin. [William S. Turner, 1st sergeant, Cth New York Independent Battery, died of pyaemia May 27, 1864, and is doubtless the patient referred to.—Ed.] On August 18, 1864, in one of our forts in front of Petersburg, Private Kelly, Co. A, Battalion of U. S. Engineers, Headquarters, Army of the Potomac, was wounded in the left knee by a sharpshooter. The ball entered somewhat to the left of the median line, near the tuberosity of the tibia, and passing upward and backward lodged in the face of the external condyle, partially imbedding itself crosswise. On consultatiou the same day the man was wounded, witli Surgeon Ghiselin, U. S. A., Assistant Surgeon J. E. Gibson, U. S. A., and Acting Assistant Surgeon Goodrich, who had charge of the case, it Avas decided to amputate through the knee-joiitt. After the usual lireliminaries, having taken a scalpel of medium size, taking position on the right side of the limb, I introduced it opposite the termination of the external condyle, and outlined an anterior flai>, the lowermost portion of Avhich was two inches below the terminal insertion of the quadriceps extensor, with a tirm cut that divided the skin and superficial fascia, terminating the primary incision of the anterior flap opposite a point of the internal condyle corresponding to the point of the external con- dyle opposite which the scalpel had been introduced. From this termination the scalpel was rev^ersed, and the inner half of the posterior flap formed, the depth of my incision being such as insured section of the superficial fascia as well as skin proper. The knife was then removed and reinserted near the original point of entrance, from which the outer half of the posterior flap was formed. This posterior flap was very long, extending fully half way down the leg. The angles of union of the anterior and lines of incision were made very acute, so that retraction would not tend to separate the angles posterior of the stump by drawing the sac of the stump tightly over the large extent of bone substance left. Tlie anterior flap was now raised, and 1 took care in raising it to dissect so as to inflict as little injury as possible upon superficial fascia. The ligament of the patella was incised closely above the tuberosity of the tibia, and the patella, with its connections, left untouched so far as practicable. The ligamentsremaiuiug were then divided at their insertion, and so cut through that the semilunar cartilages remained in the stump. All the ligaments binding the head of the tibia being thus severed with a large operating knife, I cleared the posterior flap, cutting in the plane of the retracted posterior skin flap outlined as described above. This procedure aftbrded a base of flesh to what was essentially a skin-flap. But in addition, by the method adopted, I found that the fleshy i)art of the posterior-flap had beeri so formed as to exjiose the anterior surface of the deep posterior layer of crural fascia, and expose so much of this surface that it was found that a fibrous sheet fitted upon the synovial surfaces exposed by removal of the tibia. 1 now cut away all points and strips of cartilage or fibrous tissue accidently made in operating. The ball was elevated from its bed in the face of the external condyle and this bed cleared. iSTothing unusual took place in the subsequent steps of the operation. Unfortunately, however, the silk ligature threads were rotten. There was a ball hole in the anterior flap, besides the wound in the face of the external condyle to complicate the case. The latter was oozing blood from its sides when last observed. Throughout the operation injury to what was left of the synovial sac was avoided. September 9, 1864; Kelly is doing very well. The ligatures have none of them come away yet, and gentle traction met with firm resistance this morning. He is afflicted with pains of a darting lancinating character, which shift location. The wound of entrance in the outer border of the anterior flap has healed rapidly by granulation. To a great extent the tfaps have united. A sinus, the mouth of which is to the right of the middle of the cicatricial line, communicates with the bed of the ball. So little discharge takes place through this sinus that it is thought that the bed of the ball has already been filled with callus. A peculiar leaden feeling has been observed by Kelly about his patella. He is not able to move this bone, but moves the left thigh without paiii. On September 14th Kelly](https://iiif.wellcomecollection.org/image/b21970695_0294.jp2/full/800%2C/0/default.jpg)
