A manual of operative surgery . te the hand ifrequired. A second assistantmay conveniently attend tothe sponging. The following methods ofdisarticulating will be de-scribed :— i. Circular. 2. By elliptical incision. 3. By long palmar flap. 4. By external flap (Du-brueils operation). 1. The Circular Method.— The circular incision is someway below the joint, and isinclined a little lower downupon the radial than upon theulnar side, in order that theouter styloid process may bewell cleared. The incision on the inner side is just above the base of thefifth metacarpal bone, while on the outer side
A manual of operative surgery . te the hand ifrequired. A second assistantmay conveniently attend tothe sponging. The following methods ofdisarticulating will be de-scribed :— i. Circular. 2. By elliptical incision. 3. By long palmar flap. 4. By external flap (Du-brueils operation). 1. The Circular Method.— The circular incision is someway below the joint, and isinclined a little lower downupon the radial than upon theulnar side, in order that theouter styloid process may bewell cleared. The incision on the inner side is just above the base of thefifth metacarpal bone, while on the outer side it crosses the firstmetacarpal about 1 cm. below the carpo-metacarpal joint ofthe thumb (Fig. 363, l, and Fig. 367, a). The surgeon, holding the patients hand in his left hand,makes the circular incision, commencing it upon the dorsum, andturning the hand from the prone to the supine position as theknife travels round the limb. The incision concerns at first theskin and the subcutaneous tissues only, and as it is being made. fig. 367.—A, Palmar incision in the circulardisarticulation at the wrist; B b, Incisionsin the elliptical disarticulation at the wrist. 512 AMPUTATIONS [part vi the assistant draws up the soft parts of the dorsum. The handis now allowed to drop into the prone position, while the operatordissects up the integuments of the dorsum until the joint-line isreached and the styloid processes are cleared. The left fingersare used to assist in this retraction. The surgeon once more grasps the pronated hand, andflexing the wrist to the utmost, divides the left lateral ligament( the ligament on the operators left). By continuing theincision transversely, all the extensor tendons are severed oppo-site the line of the articulation, the joint is opened, and finallythe right lateral ligament is cut. Still flexing the wrist, and sorotating the hand that the border on the surgeons right is turnedwell forward, the operator cuts the anterior ligaments close tothe car
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