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.

    131/1274 (page 99)
    seemed possible. In cases of disease of the metacarpal bone, excision of the bone should be preferred to complete amputation. Should the operati.jn, however, be necessary, it may be done either by the/tej? or the oval method. The flap method is thus peiformed : The Surgeon stands with the back of the patient's hand towards himself, the limb being midway between pronation and supination, and he holds the thumb by the ungual phalanx. In operating on the right side he commences the incision immediately above, and a little to the palmar aspect of the tubercle to be felt at the outer side of the base of the metacarpal bone ; from this point he carries a curved incision passing imme- diately below the metacarpo-phalangeal articulation on the dorsal aspect to the middle of the web between the thumb and index finger. While making this incision, the operator's hands are necessarily crossed, but this causes no in- convenience if he leans slightly over the patient's hand. Still holding the thumb, the operator now supinates the hand, and passes the knife by trans- fixion from the lower end of the first incision, in the web, to the point at which it was commenced, taking care to keep the blade close to the palmar aspect of the metacarpal bone (Fig. 39). The palmar flap is now cut, the knife being brought out in a line exactly corresponding to the incision which has been made on the dorsal aspect. During this part of the opera- tion the thumb must be slightly adducted, and care must be taken not to haggle over the sesamoid bones, and at the same time not to notch the flap by turning the edge of the knife too much towards the palm in trying to avoid them. The palmar flap being cut, the Surgeon gives the thumb to an assistant while he dissects back the dorsal flap by a few touches of the knife. This being accomplished, he again takes the thumb, and forcibly abducts it, while he carefully passes the knife down towards the joint, along the palmar aspect of the metacarpal bone, sepai'ating the re- maining attachments of the short muscles, and finally opening the articulation from its inner and palmar aspect. During this part of the operation the knife must be kept turned towards the bone, so as to avoid wounding the radial arteiy as it passes between the heads of the first dorsal interosseous muscle. As soon as the joint is opened the thumb should be separated by twisting it round while the edge of the knife is sawn gently against the base of the bone. The radial artery, as it winds below the styloid process, is easily wounded .at this stage of the operation, unless the knife is kept constantly in contact with the bone. In operating on the left side exactly the same course is followed, except that it is not necessary for the Surgeon to cross his hands, and the first incision is made from the web to the base of the bone, and the transfixion from that point to the web. In the oval method of amputating, which is, as a rule, to be preferred, the incisioji is commenced opposite the outer tubercle at the base of the metacarpal bon(!, and carried along the outer border of the bone to within about half-an- inch of the head. From this point an oval incision is carried round, passing in front over the metacarpo-phalangeal articulation, thus completing a racket- shaped incision. The flaps are then turned back, care being taken, if ])0ssiblc, not to open the metacarpo-phalangeal articulation, and the operation is con- n 2 Fig. 40.—Result of Am- putation ol'Tliuiiibaiid its Metacarpal Boue.