A manual of operative surgery . shas the advantages of affordinga good covering to the bone, awound that can be neatly ap-proximated, without allowingany pocket to be formed,and consequently good has the drawback, however^that the cicatrix is carried intothe palm The method by means ofa circular incision at the levelof the web with a median dorsalcut (Fig. 363, e), affords a most FIG. 364.—A, Disarticulation by special externo- excellent covering to the boner palmar flap; B, Disarticulation by lateral but it provides a Somewhatnaps ; C, Amputation by unequal dorso- palmar flap; D,
A manual of operative surgery . shas the advantages of affordinga good covering to the bone, awound that can be neatly ap-proximated, without allowingany pocket to be formed,and consequently good has the drawback, however^that the cicatrix is carried intothe palm The method by means ofa circular incision at the levelof the web with a median dorsalcut (Fig. 363, e), affords a most FIG. 364.—A, Disarticulation by special externo- excellent covering to the boner palmar flap; B, Disarticulation by lateral but it provides a Somewhatnaps ; C, Amputation by unequal dorso- palmar flap; D, Disarticulation by oblique Clumsy Stump. Cr wit!? its nSaSSlabone0byhracS The various . operations for incision ; F, Same operation upon the little the index and little fingers. Callfinger ; G, Dubrueils disarticulation at the r ? ?. , t^ wrist. lor no especial comment, -bara- beufs methods by interno-palmar or externo-palmar flaps are probably the best, while themethod of unequal lateral flaps is the least to be AMPUTATIONS AND DISARTICULATIONS OF THE THUMBIn performing an operation through the first or the second phalanx,or in disarticulating at the interphalangeal joint, one or other of themethods already described may be employed (Fig. 363, h, andFig. 364, c). The comments made on these operations apply equally whenthey concern the thumb. In any amputation below the interpha- chap, ii] DISARTICULATION OF THE THUMB 501 langeal joint the sheath for the flexor tendon should be closed. Thereare four digital arteries to the thumb, and two at least of these willprobably need to be secured. Disarticulation at the Metaearpo-phalang-eal Joint.—It may be remembered that the extensor primi internodii pollicis, the abductorand the adductor pollicis, and the flexor brevis pollicis, all find insertioninto the base of the first phalanx. The methods described in the previous chapter apply in generalterms to this disarticulation. The two most suitable operationsare the followi
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