A manual of operative surgery . thigh,follows a precisely oppositecourse, the incision being com-menced upon the inner aspectof the limb. (2) The assistant now re-tracts the skin while the sur-geon frees it all round. Itmust be retracted evenly, soas to preserve the originalobliquity of the incision. Itis seldom possible to turn backa cuff of skin, as some a normal adult limb such acourse is mechanically imprac-ticable. (3) When the skin has beenseparated from the deeperparts and retracted as far asrequired, the superficial mus-cles on the inner and posterioraspects of the thigh (the
A manual of operative surgery . thigh,follows a precisely oppositecourse, the incision being com-menced upon the inner aspectof the limb. (2) The assistant now re-tracts the skin while the sur-geon frees it all round. Itmust be retracted evenly, soas to preserve the originalobliquity of the incision. Itis seldom possible to turn backa cuff of skin, as some a normal adult limb such acourse is mechanically imprac-ticable. (3) When the skin has beenseparated from the deeperparts and retracted as far asrequired, the superficial mus-cles on the inner and posterioraspects of the thigh (the ham-strings, sartorius, and gracilis)are divided by a vigorous sweepof the knife. When they haveretracted, the deeper muscles are severed down to the bone at the highest possible level byanother sweeping cut. In dividing the muscles the obliquity of the original incisionis still maintained— the knife crosses the limb parallel to theoriginal skin-cut, and as close as possible to the now retractedmargin of the .—,« ...A fig. 422.—A, Circular amputation of thigh:a, Saw-line of same ; B, Disarticulation atthe hip by external racket incision. 654 AMPUTATIONS [part vi (4) The bone is cleared, retractors are applied, and the femuris sawn through. In sawing the femur the position of thethick ridge (linea aspera) at its posterior aspect is to be re-membered, and the saw, at first horizontal, must be broughtnearly vertical so soon as a groove is cut, in order that the lineaaspera may be divided early, and not left to break and form aprojecting spike (C. Heath). It is well to saw off the superior and inferior margins of theend of the bone obliquely, so as to round it. This may be con-veniently performed with a small Butchers saw. The cicatrix will be transverse or oblique. In the latter caseit will incline in front backwards and inwards. Hemorrhage.—The position of the femoral artery upon theface of the stump will depend upon the level at which the tissuesare di
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