The surgical treatment of the diseases of infancy and childhood / by T. Holmes.
- Timothy Holmes
- Date:
- 1868
Licence: Public Domain Mark
Credit: The surgical treatment of the diseases of infancy and childhood / by T. Holmes. Source: Wellcome Collection.
576/700
![case (as shown by figure 91) there was not enough of healthy soft tissue to bring the cicatrix as far back as it ought to be. 2. The patient must be in a state of health to render it probable that this long flap will not be attacked by gangrene. 3. The tibia must be extensively diseased or injured, and the femur sound. It must be obvious how seldom we shall find all these conditions united. After recovery a most excellent stump is left. The patella is, in children at least, quite movable, as in the healthy joint. This point is shown by the accompanying fig. 90, and was also proved during life by a child whom I saw at St. Mary's Hospital, where the operation had been performed by Mr. Lane. I believe the same was also the case with an adult under my own care. The face of the stump, being made of skin which has been accustomed to bear the weight of the body, is peculiarly free from irritability. Necrosis and in- flammation of the bone are probably less to be apprehended than in amputations when the bone is sawn through. One of my adult patients was attacked with severe phagedena when the wound had nearly healed; yet no bone became exposed, and after the union the stump was perfectly good. Finally, the shape of the stump is very convenient for the firm adaptation of the artificial limb. I append representations of the stump in the case above [Pig. 90. Section of the stump after amputation through the knee (Edw. J. Eade, £et. 2J), a the patella divided across. It is cartilaginous at this early age, and the parts have been drawn aside to show that it is as movable as in the I natural joint. 6 the cartilaginous surface of the femur, smooth, free from adhesions, and natural in appearance, c the capsule of the joint. From a preparation in the Museum of the Children's Hospital.] [Fig. 91. The face of the stump, show- ing the perfect union of the wound before death, and its position—not sufficiently far back, in consequence of the deficiency of sound soft parts in the front of the limb, before opera- tion.]](https://iiif.wellcomecollection.org/image/b20416325_0576.jp2/full/800%2C/0/default.jpg)
