. Operative surgery. ions. Which makes the better flap, the skinand subcutaneous tissue alone or when combined with muscular tissue, is notyet definitely settled. It is fair to say, however, that the flaps of skin are lessvital than when fortified with subjacent muscular structure. However, thisfact is not of great significance except in the enfeebled circulation of the old,or in the presence of the necessity for an inordinately long flap. While it istrue that the muscular tissue of a flap soon atrophies, yet it can not bedenied that the fibrous residue of the muscle exercises a serviceable in
. Operative surgery. ions. Which makes the better flap, the skinand subcutaneous tissue alone or when combined with muscular tissue, is notyet definitely settled. It is fair to say, however, that the flaps of skin are lessvital than when fortified with subjacent muscular structure. However, thisfact is not of great significance except in the enfeebled circulation of the old,or in the presence of the necessity for an inordinately long flap. While it istrue that the muscular tissue of a flap soon atrophies, yet it can not bedenied that the fibrous residue of the muscle exercises a serviceable influenceat the end of the stump. At all events, the integumentary portion shouldbe considerably longer than the muscular part. Surely there can be butlittle doubt of the fact that the dangers incident to infection are less pro-nounced in integumentary than in muscular flaps. Flaps are fashioned by, 1, transfixion, 2, by free deep cutting fromwithout, and, 3, by superficial division and separation of their tissues. The. Fig. 473.—Circular method. first two methods provide musculo-cutaneous flaps, the last one integumen-tary. The novice in surgery and the conceited surgeon regard it as deroga-tory to their attainments to trim or shape a flap after its division. It is farwiser, however, to make flaps of excessive length and suitably trim themthereafter, than to make them too short at the expense of the comfort andusefulness of the limb. The great danger is that flaps will be made tooshort rather than too long. The methods of amputation are classified.^ according to the outlines of theincisions, into circular., modified circular, elliptical (page 400), oval or racket,and common and special flap methods. The flaps of these methods may becomposed of integument alone, or combined with muscular tissue, and evenwith periosteum. The Circular Method.—The circular method gives an admirable is easily and consequently frequently made, and is recommended especially 454 OPERATIVE S
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