File:Modern surgery, general and operative (1914) (14596022768).jpg

Identifier: modernsurgerygen1914daco (find matches)
Title: Modern surgery, general and operative
Year: 1914 (1910s)
Authors: Da Costa, J. Chalmers (John Chalmers), 1863-1933
Subjects: Surgery Surgery, Operative
Publisher: Philadelphia, London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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s made from the carpometacarpal joint. Amputation of the thumb through its distal or proximal phalanx isperformed in the identical way employed in amputation of a finger. Ampu-tation of the thumb, with a portion or the whole of its metacarpal bone, isperformed by the oval or racket incision (Fig. 962). 1408 Amputations Disarticulation at the wrist=joint can be done by the oblique circu-lar method (Fig. 963) or by a double flap. In the double-flap amputation adorsal flap is made by carrying a semilunar skin incision between the styloidprocesses; the skin is lifted, the wrist is forcibly flexed, the joint is openedby a transverse cut, and a long semilunar palmar flap which includes only theskin and fascia is made by dissection. Kocher prefers to amputate by anobHque incision. The lower end of this incision is about the middle of thepalm and the upper end is in the line of the w^rist-joint (Fig. 963). The handis strongly flexed, the extensor tendons are divided, the posterior ligament of
Text Appearing After Image:
Pig. g63.- -Disarticulation of the middle finger. Disarticulation at the wrist-joint,through the forearm by the obhque circular method (Kocher). Amputation the joint is incised, and incisions below the styloid processes di\ade the lateralHgaments and certain tendons. The flexor tendons are separated from thebone and are di^dded so as to remain in the palmar flap. Amputation through the forearm may be effected by the obHque circularmethod (Fig. 963), the circular, the modified circular, or the flap operation. Themodified chrcular is an excellent plan. A semilunar dorsal skin-flap and a semi-lunar skin-flap on the flexor surface are made. The flaps are raised, the musclesare cut circularly (Fig. 964), the interosseous space is cleared by the knife, athree-tailed retractor is applied, the periosteum is pushed up, and the bonesare saw^n I inch above the flap. Insawing the bones, start the sawupon the radius, draw it from heelto point, make a furrow on the ra-dius and ulna, and saw both bo

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