. Manual of operative surgery. ng stops. Step 4.—Obliterate all dead spaces by means of buried catgut sutures or by FLAPS 1149 relaxation sutures. Close the skin wound by sutures converting the circularinto a transverse wound. If it is impossible to obliterate the dead spaces, ifoozing is expected or if asepsis is not sure, provide drainage either by tube,rubber tissue, or cigarette. Apply dressing and a splint. Crede (Archiv fur klin. Chir., xlviii, 514) advocates the abolition ofsutures after amputation. In place of them he uses a sort of capeline bandageof wide-meshed gauze, applied directl
. Manual of operative surgery. ng stops. Step 4.—Obliterate all dead spaces by means of buried catgut sutures or by FLAPS 1149 relaxation sutures. Close the skin wound by sutures converting the circularinto a transverse wound. If it is impossible to obliterate the dead spaces, ifoozing is expected or if asepsis is not sure, provide drainage either by tube,rubber tissue, or cigarette. Apply dressing and a splint. Crede (Archiv fur klin. Chir., xlviii, 514) advocates the abolition ofsutures after amputation. In place of them he uses a sort of capeline bandageof wide-meshed gauze, applied directly to the stump. After one or two layersof the bandage have been applied it is easy to see, through them, if the edgesof the wound are in correct apposition and if the compression exercised bythe bandage is too severe. Outside the bandage he applies the usual dressings. When, owing to the conical shape of a limb, it is impossible to reflect thetissues upwards to a sufficient extent through the circular incision, it is easy to. Fig. 1412. make one or two lateral incisions through the soft parts and so facilitate thework (Fig. 1412). If, instead of making the original circular incision exactlytransverse, it is made oblique, the result is an oval incision or practically anamputation by a single flap and the resultant scar is not over the middle ofthe stump. Thus we have the racquet incision and amputation by two equalflaps. By means of lateral longitudinal incisions (Fig. 1412) the oval amputa-tion may be converted into one having unequal flaps. When the surgeon desires to amputate by the flap method he of coursewould never dream of making the flaps in the indirect method described above,but would trace them out directly and fashion them either by cutting firstthrough the skin and then through the musculature or by transfixion. Amputation by transfixion is performed as follows. Example, amputation of the lower third of the thigh: Bring the patient so as to rest with his buttocks
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