. Railway surgery : a handbook on the management of injuries . offthe ends or heads of bones that are protruding, cut off theends of tendons and nerves, and patch the remaining skinover the end. The special indications in injuries of the hand, andhow such should be met in that region, have been fullynoted. If through the body of an extremity, flaps must betaken from the proximal part, always discarding bruisedor blackened skin, and going back until an incision can becarried into viable tissue. In fast-train injuries, or in any variety where by reasonof the actual traumatism, or on conservative
. Railway surgery : a handbook on the management of injuries . offthe ends or heads of bones that are protruding, cut off theends of tendons and nerves, and patch the remaining skinover the end. The special indications in injuries of the hand, andhow such should be met in that region, have been fullynoted. If through the body of an extremity, flaps must betaken from the proximal part, always discarding bruisedor blackened skin, and going back until an incision can becarried into viable tissue. In fast-train injuries, or in any variety where by reasonof the actual traumatism, or on conservative grounds, am-putation is to be made above the margins of the woundinto fresh, healthy tissue, an ideal amputation should bedone, choosing that method which will be the best for thecase, and doing it as any primary operation should be done,with every care and intent of its being followed by first-intention union and a solid stump. 180 RAILWAY SURGERY. Always taking time to have every detail arranged forthe purpose of doing this, the form of flaps to make pre-. 73.—Stump Resulting from the Side-flap Method. sents itself. It may be found that on account of the re-lations of the tissue at your disposal, it will be wise tochoose a side-flap operation, which presents a very good THE HOW TO AMPUTATE. 181 appearance, as shown in Fig. 73, or it may be that a Tealsmethod with a long anterior and short posterior flap can
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