A manual of operative surgery . econdition of the limb. It is indicated in the descriptions of the par-ticular amputations. In later chapters illustrations of the ordinary circular amputationare afforded by an amputation of the arm (page 536) and an ampu-tation of the thigh (page 652). (2) The circular amputation a la manchette is adapted for partswhere the covering of the bones is scanty and is composed of irregular CHAP. I] THE CIRCULAR METHOD 475 tissues. Such a region is best illustrated by the wrist, where thebones are surrounded by many tendons, and where muscular tissueis scanty and une
A manual of operative surgery . econdition of the limb. It is indicated in the descriptions of the par-ticular amputations. In later chapters illustrations of the ordinary circular amputationare afforded by an amputation of the arm (page 536) and an ampu-tation of the thigh (page 652). (2) The circular amputation a la manchette is adapted for partswhere the covering of the bones is scanty and is composed of irregular CHAP. I] THE CIRCULAR METHOD 475 tissues. Such a region is best illustrated by the wrist, where thebones are surrounded by many tendons, and where muscular tissueis scanty and unevenly disposed. In this method of amputating, the skin and subcutaneous tissuesare turned up in the form of a cuff, or manchette, and are turned backlike the cuff of a coat. The skin is divided, as in the previous opera-tion, by circular incision, and is then, together with the subcutaneoustissues, turned back as shown in Fig. 356. The turning back of thiscuff is mainly effected by the fingers of the surgeons left hand. The \ 1. FIG. 356.—CIRCULAR AMPUTATION .2 LA MANCHETTE. skin is freed by the knife, which should always be held perpendicularlyto the surface. The cuff is not dissected up. It is gently freed andturned up. If the knife be passed obliquely beneath the skin whichhas to be everted, the skin is apt to be needlessly damaged. The cuffmust be even and regular, and of a size previously determined soft parts are then divided by a circular sweep, with the knifeat the level of the retracted and everted skin. Only one such incisionwill probably be necessary. 2. The Modified Circular Method.—Three important modifi-cations need to be described : 476 AMPUTATIONS [part vi (i) In addition to the circular cut through the integuments, avertical incision is made to join the original wound. The skin oneither side of this vertical cut, and at the points where the cut joinsthe circle, is then reflected in the form of two imperfect skin modification is illustrat
Size: 1293px × 1934px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, booksub, booksubjectsurgicalproceduresoperative
