. Manual of operative surgery. lower end of the vertical incision make a circularor oblique incision through the skin and subcutaneous tissues completely roundthe thigh at a distance of 6 to 8 inches from the tip of the trochanter. Dissectthe skin upwards for about 2 inches; at this level divide the muscles and removethe limb. As soon as the muscles are divided the vessels must be method is identical with the two preceding ones except in the matter ofhemostasis. Step 4.—The limb having been removed, attend to final hemostasis. In-spect the acetabulum for disease and treat such dis
. Manual of operative surgery. lower end of the vertical incision make a circularor oblique incision through the skin and subcutaneous tissues completely roundthe thigh at a distance of 6 to 8 inches from the tip of the trochanter. Dissectthe skin upwards for about 2 inches; at this level divide the muscles and removethe limb. As soon as the muscles are divided the vessels must be method is identical with the two preceding ones except in the matter ofhemostasis. Step 4.—The limb having been removed, attend to final hemostasis. In-spect the acetabulum for disease and treat such disease if found. Close thewound after providing for drainage. Remark.—The racquet-shaped incision provides a wound which lies asmote as possible from the nates and genitalia. 2. Wyeths Amputation.—Introduce Wyeths pins (p. 1182). Apply elasticconstrictor above the pins. Step I.—Make a circular incision around the thigh about 2 to 2^^^ inchesbelow the lesser trochanter, dividing the skin and subcutaneous tissues ii86 AMPUTATION OR DISARTICULATION Reflect the skin upwards to the level of the lesser trochanter. At this leveldi\-ide the muscles circularly to the bone. Step 2.—Make a vertical incision over the line of the external surface of thefemur from the elastic constrictor to the circular incision. Ligate all the prin-cipal vessels in the wound. Step —Separate all the soft parts from the femur upwards from the circularincision. Disarticulate the hip. To accomplish disarticulation divide the cap-sular ligament, make a notch in the cotyloid ligament to permit air to enter thejoint, manipulate the Hmb to expose the ligamentum teres, divide this ligament,
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