. Operative surgery, for students and practitioners . d off, althoughthis is probably unnecessary. The anterior flexor tendons may beunited by two catgut sutures to the edge of the extensor tendons, asthis increases the probability of a movable, useful finger stump. Theedges of the skin are approximated with two to four catgut sutures,and the operation is complete. AMPUTATIONS, RESECTIONS, ETC. 521 EXARTICULATION OF THE FlNGER AT THE METACARPOPHALAN-GEAL Joint.—Amputation through the metacarpophalangeal jointmay be done with or without the removal of the head of the meta-carpal bone. Eemoval o
. Operative surgery, for students and practitioners . d off, althoughthis is probably unnecessary. The anterior flexor tendons may beunited by two catgut sutures to the edge of the extensor tendons, asthis increases the probability of a movable, useful finger stump. Theedges of the skin are approximated with two to four catgut sutures,and the operation is complete. AMPUTATIONS, RESECTIONS, ETC. 521 EXARTICULATION OF THE FlNGER AT THE METACARPOPHALAN-GEAL Joint.—Amputation through the metacarpophalangeal jointmay be done with or without the removal of the head of the meta-carpal bone. Eemoval of the head of the metacarpal bone allows theadjoining fingers to be approximated, thus diminishing, somewhat,the apparent deformity, but this is accomplished at the expense of thesolidity and strength of the hand; so that, in most cases, especiallyin laboring people, the end of the metacarpal bone is better not re-moved. The finger is seized and flexed as in the previous operation, andan incision made upon the dorsal aspect of the hand, commencing. Fig. 226.—Exarticulation of the Finger. A, incision for exarticulation atthe metacarpophalangeal joint; B, incision for amputation of finger withexcision of the head of the metacarpal bone; G indicates long anterior flap inexarticulation through the phalango-phalangeal joint. one-half inch above the point of the knuckle and carried down asfar as the level of the web of the finger. This incision should pene-trate to the bone, dividing the skin and also the aponeurotic expansionof the extensor tendon. At the lower end of this incision, upon alevel with the web of the finger, a second incision is carried aroundthe finger, cutting all the structures, including the anterior and poste-rior tendons, down to the bone. A corner of the flap is now seized, the finger being drawn towardthe opposite side, and the flap, including the tendinous expansion, isstripped away from the bone with the knife; this is then done, in asimilar manner, with
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