A manual of operative surgery . g the surgeon and LATION AT THE r p 1 1 1 i 1 shoulder by upon the other side of the table, or by the RACKET INCISION. 1 1 1 (Spences operation.) SnOUlQer. i. The Racket Method. (a) SpencesOperation.—The following is Prof. Spences own account ( Lec-tures on Surgery, vol. ii., page 662) :— (1) Supposing the right arm to be the subject of ampu-tation. The arm being slightly abducted, and the head of thehumerus rotated outwards if possible, with a broad strongbistoury I begin by cutting down upon the head of the humerus,immediately external to the coracoid process,
A manual of operative surgery . g the surgeon and LATION AT THE r p 1 1 1 i 1 shoulder by upon the other side of the table, or by the RACKET INCISION. 1 1 1 (Spences operation.) SnOUlQer. i. The Racket Method. (a) SpencesOperation.—The following is Prof. Spences own account ( Lec-tures on Surgery, vol. ii., page 662) :— (1) Supposing the right arm to be the subject of ampu-tation. The arm being slightly abducted, and the head of thehumerus rotated outwards if possible, with a broad strongbistoury I begin by cutting down upon the head of the humerus,immediately external to the coracoid process, and carry theincision down, through the clavicular fibres of the deltoid andpectoralis major, till I reach the humeral attachment of thelatter muscle, which I divide. I then, with a gentle curve, carry the incision across andfairly through the lower fibres of the deltoid towards the posteriorborder of the axilla, unless the textures be much torn. (The in-cision so far is carried the whole length directly down to the bone.). chap, v] DISARTICULATION AT THE SHOULDER 547 I next mark out the line of the lower part of the innersection by carrying an incision through the skin and fat only,from the point where my straight incision terminated ( atthe lower end of the insertion of the pectoralis major), acrossthe inside of the arm, to meet the incision at the outer part(Fig. 376). This ensures accuracy in the line of union, but isnot essential. (2) If the fibres of the deltoid have been thoroughlydivided in the line of incision, the flap so marked out can beeasily separated (by the point of the finger, without furtheruse of the knife) from the bone and joint, together with the trunkof the posterior circumflex, which enters its deep surface, and bedrawn upwards and backwards so as to expose the head andtuberosities. (3) The tendinous insertions of the capsular muscles, thelong head of the biceps and the capsule, are next divided bycutting directly on the tuberosities and head of
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