. Operative surgery. Fig. 550.—Larreys method. Fig. 551.—Forming inner flap. is exposed; then the ligaments and muscular attachments are divided, dis-articulation is accomplished, and the limb removed by dividing the remain-ing soft parts at the axillary aspect. The Remarks.—Spences method is valuable because it admits of a choicebetween excision and amputation. In very muscular subjects a redundancyof muscular tissue in the fiap can be avoided by dissecting the integumentand subcutaneous tissues a short distance upward over the deltoid, and divid-ing its fibers high up. It will be noted that
. Operative surgery. Fig. 550.—Larreys method. Fig. 551.—Forming inner flap. is exposed; then the ligaments and muscular attachments are divided, dis-articulation is accomplished, and the limb removed by dividing the remain-ing soft parts at the axillary aspect. The Remarks.—Spences method is valuable because it admits of a choicebetween excision and amputation. In very muscular subjects a redundancyof muscular tissue in the fiap can be avoided by dissecting the integumentand subcutaneous tissues a short distance upward over the deltoid, and divid-ing its fibers high up. It will be noted that the external- and internal-flap method (Fig. 545)meets very many, indeed, of the considerations regarded as wise in amputa-tion at the shoulder joint. The oval method damagesthe deltoid muscle considerably. The circular andSpences methods are not much removed from eachother in operative advantages. However, the latter isthe more artistic, and is the more commonly employed ofthe two. The Results.—Of 1,629 disa
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