The principles and practice of modern surgery / by Roswell Park ... with 722 engravings and 60 full-page plates in colors and monochrome.

  • Roswell Park
Date:
1907
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of modern surgery / by Roswell Park ... with 722 engravings and 60 full-page plates in colors and monochrome. 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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    l;it('r;il incision.-; |K'riiiit, and (lien llic lihula lirsl and later tlic lihia divided. It is |trac(ii'all_v a .snl)|>i'ri(>.steal excision of tlu' lei;- hones and all'ords a well-prolccted .stump. In ellecl it is an anten)|)osleri()r flap method. The Knee.- It was Hrinton who, in 1S72, suo;oested tlie j)reservuti()ii of the semi- hmar carlila;;('s in all knee disarticuhitions, as in this way all the normal relations arc preserved and retraction is prevented. But the makers of jirosthetic apparatus have m-^'cd to ahandon all true disarticulations, and to substitute for them the su|)racondyloid method, which affords ideal stumps. Disarticulations are supposed to produce less shock, less loss of blood, and less danoer of sepsis from openintf uj) the bone-marrow, while nuiscle insertions are less disturbed and tlie stump covering; usually is mobile and not very sensitive. No disarticulation should be thou<>ht of unless the joint involved be free from disea.se and unless about it (here I)e met suflicient healthy inte<!;ument to furnish a satisfactory flap. For a true (ILs-articiilation Stephen Smith's bilateral method Is no\v almost universally a(lo])te(l. Here the incision is begun one inch below the tubercle of the tibia and is carried directly down to the bone, downward and forw^ard around the side of the leg, and then inward and upward toward the middle of the j)opliteal space, the lateral flaj)s Fici. 7U) Amputation at knee by lateral tlap. (Erichsen.) Stump after Stephen .Smith's amputatiun at knee. thus made being nearly duplicates. The flaps thus cut out are com- pletely separated from the bone up to the joint level, where the liga- ments are divided, the joint being manipulated as may be necessary to best expose them and facilitate di- vision. In this operation the patella is usually removed, the joint being opened by separating its ligament at - its insertion into this bone. One should remember that the internal condyle is lower and longer than the external, and that the internal flap should be perhaps made on this account a little the longer of the two. Fig. 710 illus- trates the stump resulting from this operation and shows the cicatrix drawn up out of harm's way and resting in the fossa between the condyles. Fig. 711 illustrates the sim])le method by lateral flaps. Amputation of the Thigh.—Under this head, rather than that of amputation at the knee, should be described the supracondijloid amputations which give decidedly the best results of all, and which are preferable to any others for the middle of the lower extremity. Of these the best Is that suggested by Grlttl, wdiich consists in not only removing the condyles but saAvIng off the articular surface of the patella, which is then drawn upward and applied to the end of the femur, the division of the latter being made at a point above the condyles, where the diameter of both bones will nearly correspond, this latter perhaps being a suggestion of Stokes rather than of GrittI, wdio did not divide the bone quite so high. (See Fig. 712.) Fig. 712 wall best illustrate the intent of the method as well as its performance. The incisions are planned much as in the Stephen Smith disarticulation method, only they are placed higher, and the patellar tendon Is divided as low down as possible, or even separated from the tibia, in ordc that it may be made of use In attaching the divided