. The principles and practice of modern surgery . gh the muscles in front of the joint, and cutting upw^ards and forwards,so as to make a flap of them. Then the operator (who stands on the innerside for the right arm, and vice versa) makes a transverse incision behind the joint. He next cuts through theFig- 184 external lateral ligament, and enters the joint between the head of the ra-dius and external condyle, thendivides the internal lateral ligament,and, lastly, saws through the olecra-non, the apex of which, with thetriceps attached to it, is of courseleft in the stump. VII. Amputation of
. The principles and practice of modern surgery . gh the muscles in front of the joint, and cutting upw^ards and forwards,so as to make a flap of them. Then the operator (who stands on the innerside for the right arm, and vice versa) makes a transverse incision behind the joint. He next cuts through theFig- 184 external lateral ligament, and enters the joint between the head of the ra-dius and external condyle, thendivides the internal lateral ligament,and, lastly, saws through the olecra-non, the apex of which, with thetriceps attached to it, is of courseleft in the stump. VII. Amputation of the Fore-arm should always be performedas near the wrist as possible. (1.) Circular.—The limb beingsupported with the thumb upper-most, and an assistant drawing upthe skin, a circular incision is madethroughit down to the fascia. Whenthe skin has again been retracted asmuch as possible, the muscles aredivided by a second circular inci-sion ; the interosseous parts and theremaining fibres are next cut through with a catline ; the flesh is drawn. AMPUTATION OF THE HAND. 541 up with a three-tailed retractor, one tail of which is put between thebones, and the bones are then to be sawn through together, the saw beingworked perpendicularly. The radial, ulnar, and two interosseous arteriesrequire ligature, (2.) Flaps.—The limb being placed in a state of pronation, the surgeonmakes a flap from the extensor side, just as is represented in Fig. 184;and he then transfixes the flexor side, and makes the other flap ;—taking care not to 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, a
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