Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • John Eric Erichsen
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    101/1274 (page 69)
    essential service to the patient. Teale advised, liowever, that the whole pressure be not borne on the end of the bone, but that it be reduced to one- half by an elastic pad composed of numerous layers of flannel beneath the end of the stump, the remainder of the weight being distributed in the usual way on the upper part of the limb : thus not only relieving the stump, but securing greater steadiness of gait. In the upper exti'eraity, however, no direct pressure is made npon the end of the stump in the adaptation of artificial limbs; hence, the rectangular appears in these situations to possess no advantage over the other double-flap methods, so far as the utility of the stump is concerned. But, whilst fully admitting the advantage possessed by the rectangular method in the formation of a well-covered stump, especially in the lower extremity, we must not close our eyes to certain disadvantages which appear to me to be inseparable from it. One disadvantage consists in the necessity of sawing the bone at a higher point when one flap is made of such extreme Fig. '25.—Lines of Incision in Tcale's Anipntatiou. Fig. 2ii.—Teale's Amputation : Stuiii]i. length than when two shorter ones more nearly equal are fashioned. Thus, for instance, in an amputation of the thigh for injury about the knee-joint, the long rectangular flap in an adult would require to be aboi;t 8 iiiches in length, and the femur must consequently be sawn at least as far as this above the patella : whei'eas, in the ordinary double-flap amputation, two shorter flaps, each about 4 inches in length, will be found sufficient to cover in the bone, which may consequently be sawn at a proportionately lower point. Thus the rectangular method contravenes the principle in amputation, not to remove the limb at a higher point than is absolutely necessary, the danger to life increasing with every inch that is removed. In amputations for malignant disease, also, the long flap, which has to be cut close to the morbid growth, w'ould run a greater risk of infiltration than two shorter ones taken higher up in the limb : the bone in both cases being sawn at the same level. Should union by the first intention i'ail and suppuration ensue, in the rectangular amputation the thick fleshy mass which enters into the formation of the long flap becomes a source of great inconvenience, bulging out from under the skin, and requiring considerable management in the after-treatment. For these reasons the unmodified form of Teale's amputation is hardly to be recommended. Amputation liy the long. Anterior Flap.—At tlie time that Teale was l ecommending the long rectangular flap in all parts of the body, Garden, of WorcOster, was advocating the employment of a long anterior flap in a form of amputation invented by him for removal of the thigh immediately above the knee. In his operation, which will be described amongst the special amputations, a single long anterior Hap was made, the extremity of which was rounded in form. k^pencc of Edinburgh, who fully recognised the advantages of Teale's