. The principles and practice of modern surgery . pass the knife between the bones, whilst performingeither transfixion. The interosseous parts are next divided, the fleshdrawn upwards, and the bones sawn through. If the tendons project,they must be shortened. VIII. Amputation of the Wrist.—(1.) Circular.—The skin beingpulled back, a circular incision is made a little below the level of the linethat separates the forearm from the palm of the hand. The externallateral ligament is then cut through, and the knife carried across the joint,to divide the remaining attachments. (2.) Flaps.—A semi-lun
. The principles and practice of modern surgery . pass the knife between the bones, whilst performingeither transfixion. The interosseous parts are next divided, the fleshdrawn upwards, and the bones sawn through. If the tendons project,they must be shortened. VIII. Amputation of the Wrist.—(1.) Circular.—The skin beingpulled back, a circular incision is made a little below the level of the linethat separates the forearm from the palm of the hand. The externallateral ligament is then cut through, and the knife carried across the joint,to divide the remaining attachments. (2.) Flaps.—A semi-lunar incision is made across the back of thewrist, its extremities being at the styloid processes, and its centre reachingdown as far as the second row of carpal bones. This flap being dissectedup, the joint is opened behind, the lateral ligaments are cut through, andthe knife, being placed between the carpus and bones of the forearm, ismade to cut out a flap from the anterior surface of the palm, as representedin the next figure. Fig. 185,. This operation is scarcely to be preferred to amputation of the forearmlow dowm, as the flaps with their numerous tendons may not unite readily,and there may be a difficulty in preserving flesh enough to cover the endsof the bones. IX, Amputation of the Hand,—(1,) Amputation oi \he fingers orthumb at their last joint may be performed thus: The surgeon holds thephalanx firmly between his finger and thumb, and bends it, so as to giveprominence to the head of the middle phalanx. He then makes a straightincision across the head of the middle phalanx, so as to cut into the joint,and takes care to carry it deeply enough at the sides to divide the lateralligaments. The joint being then thoroughly opened, the bistoury is car-ried through it, and made to cut a flap from the palmar surface of the last46 542 AMPUTATION OF THE FINGERS. phalanx, sufficient to cover the head of the bone; and it is better to leavetoo much than too little. Fig. 186.
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