. Text-book of operative surgery . ordingly, when oblique incisions are made, the upper end should fall over the I I internal bicipital sulcus. The biceps retracts to a great extent. A simple circular incision answers admirably if the soft parts are sufiiciently pushed back subperiosteally. The surgical neck of the humerus limits the height up to which a useful stump can be got in amputating through the upper arm, because the capsule extends down to this level internally. The other factors cletermining the future usefulness of the stump are the insertions of the deltoid, pectoralis major, and
. Text-book of operative surgery . ordingly, when oblique incisions are made, the upper end should fall over the I I internal bicipital sulcus. The biceps retracts to a great extent. A simple circular incision answers admirably if the soft parts are sufiiciently pushed back subperiosteally. The surgical neck of the humerus limits the height up to which a useful stump can be got in amputating through the upper arm, because the capsule extends down to this level internally. The other factors cletermining the future usefulness of the stump are the insertions of the deltoid, pectoralis major, and latissimus dorsi muscles, these being the chief adductors and abductors of the stump. In amputating near the Shoulder it is very essential that the function of the musclesshould be retained, the best incisions to use here being either the racket or lanceolate AMPUTATIONS AND DISARTICULATIONS 375 Median n. and aiit. )inteross a. and v Supin. brevis m. Ext. carp. rad. longior\and brevior. / Rad. n. and a. with two veinsSup. longus m. Flex. profundus digit. m. Ulnar a. and two veins,Ulnar n. Flex. carp. ulnaris m. Elex, sublim, digit. m. ( Flex. carp. rad. m. and palmaris longus ib. Fig. 247.—Disarticulation at tlie elbow-joint by a circular incisiou. The incision has beeu made downto the bone, and a muscle-stump provided by subperiosteal removal of the bones of theforearm. The soft parts are retracted upwards, and the Joint is opened from in front. variety. The longitudinal portion of the incision is niacle in the interval between themuscular groups supplied by diiferent nerves, it should be made down to the boneat the anterior border of the deltoid between the internal and external rotators of the 576 OPERATIVE SURGERY humerus. The transverse portion encircles the limb about three-fiftlis of its diameterbelow tbe level at which tbe bone is divided, after the periosteum has been detachedand the bone sawn across. 63. Disarticulation at the Shoulder (Figs. 251, 252). What ha
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