Operative surgery, for students and practitioners . knee-joint. Two lateral flaps with rounded corners are thus marked should avoid making the flap scant by getting well upon theposterior aspect of the leg before turning the incision upward intothe popliteal space. This tegumentary flap, which includes the subcutaneous fat, isnow seized with the fingers and dissected away from the deep fasciawith long sweeps of the knife, its edge being directed toward thedeep fascia so as not to cut into the flap. Considerable traction shouldbe applied to the flap as it is being reflected, in order to
Operative surgery, for students and practitioners . knee-joint. Two lateral flaps with rounded corners are thus marked should avoid making the flap scant by getting well upon theposterior aspect of the leg before turning the incision upward intothe popliteal space. This tegumentary flap, which includes the subcutaneous fat, isnow seized with the fingers and dissected away from the deep fasciawith long sweeps of the knife, its edge being directed toward thedeep fascia so as not to cut into the flap. Considerable traction shouldbe applied to the flap as it is being reflected, in order to facili-tate its separation from the deep fascia. The flap should be dis-sected up to the level of the joint all around. While the flap isretracted the knee-joint is shar|3ly flexed and entered, cutting first AMPUTATIONS, RESECTIONS, ETC. 791 through the lower part of the ligamentiim patella^; the bhide of theknife is then introduced, flatwise, between the semilunar fibro-carti-lages and the upper surface of the tibia, and the cartilages separated. Fig. 348.—Right Leg, Outer Side. A, outline of hooded skin flap in am-putation of the leg. Dotted line shows line of division through bones. B,outline of skin flap in Stephen Smith hooded flap for exarticulation at theknee-joint. all around from the edge of the upper surface of the tibia, so thatthey may be left attached in the stump after the leg has been am-putated. 793 LOWER EXTREMITY. The lateral ligaments are cut on each side^ and with the limbstill strongly flexed the attached ends of the fibro-cartilages and thecrucial ligaments are cut away from the upper surface of the tibia,and then, with a long knife, the soft parts behind the joint, theposterior ligament, popliteal vessels, etc., and tendons and muscle,are cut square through from within the joint. The amputation isthus complete. The popliteal artery and its vein, which lies upon (superficialto) it, are each seized and tied. They lie close to the posterior sur-face of th
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Keywords: ., bookauthormcgrathj, bookcentury1900, bookdecade1910, bookyear1913
