. Modern surgery, general and operative. 1049.—IModified circular amputa-tion of the forearm (Bryant). Fig. 1050.—Disarticulation of the elbow-joint bythe oblique circular method (Kocher). lar flaps are made. The long flap is equal in width and length to one-half thecircumference of the hmb at the point where it is to be sawn. The short flap isequal in width to the long flap, but is only one-fourth its length. The twolongitudinal cuts are at first taken only through the skin, but the two transversecuts go at once to the bone. The flaps are dissected up from the interosseousmembrane and the bon
. Modern surgery, general and operative. 1049.—IModified circular amputa-tion of the forearm (Bryant). Fig. 1050.—Disarticulation of the elbow-joint bythe oblique circular method (Kocher). lar flaps are made. The long flap is equal in width and length to one-half thecircumference of the hmb at the point where it is to be sawn. The short flap isequal in width to the long flap, but is only one-fourth its length. The twolongitudinal cuts are at first taken only through the skin, but the two transversecuts go at once to the bone. The flaps are dissected up from the interosseousmembrane and the bone. In the middle or the upper third of a fleshy armtwo semilunar skin-flaps can be cut from without inward, and the muscles can becut by Fig. 1051.—Use of Wyeths pins in amputation at the shoulder-joint. The acromion is marked by a black line (Keen). Disarticulation at the elbow=joint can be done by the elliptical methodor by a long anterior and short posterior flap. In Kochers oblique operationthe incision begins anteriorly over the joint-Une and ends posteriorly a handsbreadth below the summit of the olecranon (Fig. 1050). A posteriorflap whichcontains the integument, the insertion of the triceps, the anconeus, and theperiosteum^ is dissected up until the posterior surface of the humerus is joint is opened anteriorly by a transverse incision, and the radiohumeralarticulation is opened from without inward (Kocher). In the double flapoperation the forearm is partly flexed and a skin-cut marks out a long anterior 1560 Amputations flap, the knife being entered opposite the external condyle and being with-drawn I inch below the internal condyle. The muscles, which are bunchedforward, are cut by transfixion.
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