. Operative surgery. ngth one half thediameter of the limb. The integumentary struc-ture of both flaps is first divided with a largescalpel. Then the tissues of the anterior flapare pinched up with the thumb and fingers anddivided obliquely downward and upward to thebone with a long knife. The muscles of theposterior flap can be divided from without, as in Fig. 640.—a. Long anterior- andthe preceding flap, oi- by transfixion and obliqne ffnlS^^ ZfX-downward division. The flaps are then retract- articulation),ed, and the bone is exposed and sawed as usual. The General Remarhs.—ln amputation at
. Operative surgery. ngth one half thediameter of the limb. The integumentary struc-ture of both flaps is first divided with a largescalpel. Then the tissues of the anterior flapare pinched up with the thumb and fingers anddivided obliquely downward and upward to thebone with a long knife. The muscles of theposterior flap can be divided from without, as in Fig. 640.—a. Long anterior- andthe preceding flap, oi- by transfixion and obliqne ffnlS^^ ZfX-downward division. The flaps are then retract- articulation),ed, and the bone is exposed and sawed as usual. The General Remarhs.—ln amputation at the thigh the periosteal portionof the flaps should be formed to correspond as nearly as practicable withthe outlines of the major parts of the flaps, so that when the borders of theformer are united together (Fig. 6-13) the end of the bone will be suitablycovered. The suturing over the end of the lone of a recent stump, by chromicizedcatgut, of a periosteal flap (Figs. 6-il, 643), along with its immediate nms-36. 538 OPERATIVE SURGERY. cular tissue connections (Fig. 641), exercise an important preservativeinfluence on the nutrition of the end of the bone, and in obviating abnor-mal deviations of growth (bony spines), and also in limiting undue retractionof the deep soft tissues at that situation. When this measure is supple-mented by buried suture apposition of the overhanging muscular flaps(Fig. 642), especially in the instances of thigh and arm amputation, greatbenefit follows, because muscular retraction of the entire stump is inhib-ited, thereby promoting prompter and better union and the making of abetter stump. In the absence of these measures, undue muscular retractionencouraged by a fixed position of the stump (especially of the thigh) leadsmuch too frequently to an unserviceable caused by a tender protruding bone.
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Keywords: ., bookauthorbryantjosephdjosephde, bookcentury1900, bookdecade1900
