. Minor and operative surgery, including bandaging . formed. This flap is held up, the bonesare disarticulated, the attachment of the triceps tendon tothe olecranon is divided, and any tissues which haveescaped division along the posterior aspect of the limbare severed. After the vessels have been secured, the flapis turned over and sutured, and a curved cicatrix on theposterior aspect of the limb results. Fig. 404. AMPUTATIONS OF THE ARM. The arm may be removed at any point below the attach-ment of the muscles at the axilla, by either the circular,flap, oval, or modified circularmethod. Circu
. Minor and operative surgery, including bandaging . formed. This flap is held up, the bonesare disarticulated, the attachment of the triceps tendon tothe olecranon is divided, and any tissues which haveescaped division along the posterior aspect of the limbare severed. After the vessels have been secured, the flapis turned over and sutured, and a curved cicatrix on theposterior aspect of the limb results. Fig. 404. AMPUTATIONS OF THE ARM. The arm may be removed at any point below the attach-ment of the muscles at the axilla, by either the circular,flap, oval, or modified circularmethod. Circular Method.—This am-putation is usually employed inremoving the arm in its lowerthird. A circular incision ofthe skin and subcutaneous tis-sue is first made, and when thecuff has been dissected up, a cir-cular division of the muscles ismade; after applying the re-tractor the bone is sawed through(Fig. 404). Transfixion Method.—Fromthe central position of the bonein the arm the flap method inamputating the arm is preferred by many operators. The. Circular amputation of the arm.(Smith.) 504 AMPUTATIONS. arm being grasped by the hand, the point of a medium-sized amputating-knife is thrust through the arm so as topass over the humerus and make its exit at a correspond-ing point in the skin on the opposite side; a flap of suffi-cient length is cut from within outward. The knife isnext passed behind the bone and a posterior flap is cut inthe same manner (Fig. 405); the bone is next cleared ofmuscular tissue, the flaps are retracted, and it is dividedwith a saw. Lateral flaps may be made in this amputation insteadof the antero-posterior flaps, and they may be cut fromwithin outward in the same manner. Fig. 405. Amputation of the arm by transfixion. (Bryant.) Modified Circular Method.—This method of amputat-ing the arm is also employed with advantage. Two ovalflaps of skin and cellular tissue are dissected up, and themuscles divided by a circular sweep of the knife. In high amput
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