The surgeon's handbook on the treatment of wounded in war : a prize essay . the hip by the flap operation. (3. .Disarticulation at the hip by the circular method. 1. By a strong and rapid sweep of the knife a circular incisionis made 12cm below the top of the great trochanter, and all the softparts together divided right down to the bone; the latter is then im-mediately sawn through. 2. All the vessels — arteries and veins — which can be recognizedare seized with artery forceps and tied with catgut (see transversesection of the thigh in its upper third on plate XXX, fig. II). 3. In those cases
The surgeon's handbook on the treatment of wounded in war : a prize essay . the hip by the flap operation. (3. .Disarticulation at the hip by the circular method. 1. By a strong and rapid sweep of the knife a circular incisionis made 12cm below the top of the great trochanter, and all the softparts together divided right down to the bone; the latter is then im-mediately sawn through. 2. All the vessels — arteries and veins — which can be recognizedare seized with artery forceps and tied with catgut (see transversesection of the thigh in its upper third on plate XXX, fig. II). 3. In those cases, in which the bloodless method from some reasonor other cannot be safely employed, it is advisable (Larrey), before thecircular incision is made, to expose the femoral artery and vein in theiliofemoral triangle by a vertical incision. These are then each securedby two pairs of artery forceps, and the vessels divided between thetwo: the lower ends are ligatured, but the upper ends are turned up-wards, and left till the amputation is finished (fig. 421). 233 Fig. Disarticulation at the hip (by the circular method;. 4. After the elastic ligature has been removed and all the bleedingarrested, a knife is pushed 5cm above the top of the great trochanteron to the head of the femur, and carried down over the middle of thegreat trochanter to the circular incision, dividing throughout the softparts down to the bone (Dieffenbach). 5. The operator seizes the stump of the femur with a strong pairof forceps, and while the edges of the vertical incision are separatedby an assistant, he strips the periosteum from the bone with the raspa-tory, till he comes to the attachments of the muscles; these must beseparated from the bone with a strong knife. 6. When the bone has been in this manner exposed up to thecapsule, the joint is opened as described above, and the head dislo-cated (fig. 422). The haemorrhage at this part of the operation isgenerally insignificant. 234 Fig. 422.
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