The surgeon's handbook on the treatment of wounded in war : a prize essay . the stump. 7. If the muscles are largelydeveloped, the double circular in-cision can be employed insteadof the single; or a large anteriorflap can be formed, and the softparts divided behind by a cir-cular incision below the glutealfold. 8. If there are not sufficientsoft parts on the anterior aspect,a large flap can also be formed 235 from the tissues behind (von Langenbeck), and a transverse incisionmade in front below Pouparts ligament. But then a stout drainagetube must be pushed in towards the stumps of the divide
The surgeon's handbook on the treatment of wounded in war : a prize essay . the stump. 7. If the muscles are largelydeveloped, the double circular in-cision can be employed insteadof the single; or a large anteriorflap can be formed, and the softparts divided behind by a cir-cular incision below the glutealfold. 8. If there are not sufficientsoft parts on the anterior aspect,a large flap can also be formed 235 from the tissues behind (von Langenbeck), and a transverse incisionmade in front below Pouparts ligament. But then a stout drainagetube must be pushed in towards the stumps of the divided psoas andiliacus, which retract into the cavity of pelvis, so that there may beno retention of pus. s. Reamputation. 1. If in an amputation sufficient soft parts have not been pre-served (to cover the end of the bone), or the soft parts have retractedduring their healing in consequence of an inflammatory swelling (ostitis),or been destroyed by gangrene, a so called conical stump is formed(fig. 424), that is, the end of the bone projects so far forwards, that Fig. Conical stump. cicatrisation is never completely accomplished (ulcus prominens), orthe thin cicatrix, which is at last produced, breaks out again, assoon as the patient begins to use a wooden stump, or an artificial stumps, which are left after frost bite or a bad burn, are generallyin a similar condition. 2. Formerly in such cases the limb was amputated again higherup, or an attempt made to cover the cicatrix by skin grafting. Butthe former is generally unnecessary, and as dangerous to the life of thepatient as the first amputation; while the latter rarely yields a satis-factory result, because the skin on the extremities is not very suitablefor plastic operations. 256 3. A subperiosteal excision of the end of the bone is much moresatisfactory. The cicatrix or ulcerated surface on the projecting boneis freed from the tissues by an incision carried round with a strongknife: the soft tissues are then div
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