. Operative surgery. ^ The Oval or Racket Method.—The oval or racketmethod is in reality a modified circular amputation, theflap being slit up at one side and the angles trimmedoff (Fig. 479). This flap is employed principally indisarticulations, and will be described in connection withthose operations. Oval-shaped flaps may be either uni-lateral, bilateral, anterior, or posterior. The Single-flap Method.—The single flap is suitedto those cases where the tissues of one side of a limb only are availablefor the purposes of a flap, as in the case of unilateral lacerations, ulcera-. PiG. 479.—Rack
. Operative surgery. ^ The Oval or Racket Method.—The oval or racketmethod is in reality a modified circular amputation, theflap being slit up at one side and the angles trimmedoff (Fig. 479). This flap is employed principally indisarticulations, and will be described in connection withthose operations. Oval-shaped flaps may be either uni-lateral, bilateral, anterior, or posterior. The Single-flap Method.—The single flap is suitedto those cases where the tissues of one side of a limb only are availablefor the purposes of a flap, as in the case of unilateral lacerations, ulcera-. PiG. 479.—Racketflap at shoulder. AMPUTATIONS. 457 tions, etc. This flap may be composed of the muscular tissues and integu-ment, or of integument alone (Fig. (516), and can he made either by trans-fixion or division from without. If possible, a short convex flap is made onthe opposite surface of the limb. The doiihle-flap metliod is performed by transfixion, and includes themuscles down to the bone on either aspect of the limb (Figs. 480 and 481).The tissues to be transfixed are raised slightly by the left hand of theoperator, who then enters the point of the knife at the side nearest him-self, pushing it through slowly in close contact with the anterior surfaceof the bone, slightly raising the handle as it passes in front of the bone,thereby causing its point to emerge at the opposite side of the limb at apoint exactly opposite to that of entrance; the flap is then made by cut-ting with a sawing motion obliquely upward and forward. This flap ispulled backward by an assistant, and
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