. Modern surgery, general and operative. for amputation. 1. If the skin has been so crushed or torn that it is obvious that at least three-fourths of the skin of the periphery and over the fracture will slough—amputate. 2. If the entire periphery of the limb at or near the site of fracture has beensubjected to a destructive circular or annular pressure—amputate. 3. If there is much annular laceration of the skin and the muscles are alsobadly crushed or torn—amputate. 4. If the limb has been subjected to immense pressure (as by a car wheel) andthe skin though intact, so completely cut off from
. Modern surgery, general and operative. for amputation. 1. If the skin has been so crushed or torn that it is obvious that at least three-fourths of the skin of the periphery and over the fracture will slough—amputate. 2. If the entire periphery of the limb at or near the site of fracture has beensubjected to a destructive circular or annular pressure—amputate. 3. If there is much annular laceration of the skin and the muscles are alsobadly crushed or torn—amputate. 4. If the limb has been subjected to immense pressure (as by a car wheel) andthe skin though intact, so completely cut off from nourishment that its doomis sealed, the muscles torn and the bone comminuted—amputate. 5. A nerve trunk can usually be sutured. If the chief blood-vessels are tornacross in the usual jagged way either anastomosis or transplant will be useless,and the surgeon should amputate. 6. If the comminution is so extensive,that the fragments be free and strippedof periosteum and the condition would demand the sacrifice of 3 inches or more. Fig. 317.—Fenestrated plaster-of-Paris dressing. Drainage-tube pulled through limbIf Dakins fluid is used this drainage is not employed. of the shaft, and if (as is almost sure to be the case) there are extensive lacerationsof muscles and skin—amputate. If an attempt is made to save the limb, be ready at any time to amputatefor gangrene, secondary hemorrhage (if religation at original point and compres-sion high up fail), extensive cellulitis, and profuse and prolonged suppuration.^When it is determined to try to save the limb, the part must be cleansedthoroughly by the antiseptic method (in no injuries is this more important).If a small portion of bone protrudes, cleanse the skin of the extremity and theprotruding bone, push the spicule out a little more, and cut it off. If a largepiece of bone is protruded it must not be cut away, but should be thoroughlydisinfected, and after the skin wound has been enlarged should be returned intoplace.
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