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Raise an anterior convex flap, consisting of integument, and a moderately thick layer of muscular tissue, the length of two thirds the measurement of the circumference of the limb. Reflect a posterior cel. lulo-cutaneous convex flap, one third the circumference of the limb in length.
Divide the remainder of the soft parts circularly. Provide a periosteal flap and retract the tissues about two inches. Saw the bone. Occlude the femoral and profunda arteries.
Esmarch's Operation.—Raise two lateral flaps of moderate length. Divide all the soft parts circularly to the bone. Push up the periosteum to the extent of an inch or more, and saw through the bone.
Suture the periosteal flap over the end of the bone, and then the muscles together by means of buried sutures. Suture the flaps
Suture the flaps together, making no provision for drainage.
Disarticulation at the Ilip-Joint.—Bring the nates over the edge of the table; control the vessels as described by means of the elastic tubing (Lloyd).
Jordan's Operation.—Hold the thigh at an angle of 45° with the axis of the body. Begin an incision three inches above the middle of the upper border of the great trochanter, and continue it downward, along the outer surface of the thigh, dividing all the tissues to the bone. Separate the periosteum from the bone down to the proposed level of division of the soft parts (Ollier).
Disarticulate the hip-joint as in resection. Divide the soft parts by the circular method at as low a level as possible.
Occlude the femoral and profunda arteries.
This method of amputating is applicable to the shoulder-joint.
Transfixion (Liston).—Place the subject so that the nates project beyond the table. Abduct the opposite limb, and lift up the scrotum. Slightly flex the hip-joint, and rotate the limb inward.
On the left side transfix the tissues in front of the joint, from a point midway between the anterior superior spine of the ilium and the great trochanter, to a point anterior to the tuberosity of the ischium. Guard against piercing through the foramen ovale. On the right side, the point of the knife is entered anterior to the tuber ischii.
Cut downward, following the bone closely, for five or six inches. (An assistant can now pass his fingers under the flap, and press the vessels against his thumbs, placed over the flap.) Turn the edge of the knife perpendicularly to the flap, and cut directly to the surface.
Abduct and rotate strongly outward the joint. The capsule may have been opened by the first thrust of the knife. Divide the capsule, and partially dislocate the head of the femur, when the ligamentum teres can be divided, and the disarticulation completed.
Pass the knife behind the head of the bone. Adduct and rotate inward, when the trochanter major will not interfere with the formation of a posterior flap four or five inches in length.
(Guthrie cuts the flaps from the surface toward the bone.)
Occlude the femoral vessels, the profunda, the obturator, and sciatic arteries.
Abdominis, paracentesis, 12.
of forearm, 129.
of toes, 133.
Aural specula (Gruber and Toynbee), 1.
of larynx, 4.
of posterior urethra, 61.
Disarticulation at ankle-joint, 138.
at elbow, 130.
of wrist, 127.
Elbow, disarticulation at, 130.
Joint, resection at shoulder, 112.
Jordan's operation, 145.
Knee, disarticulation at, 141.
Knife, manipulation of amputating,
Knot, reef, 27.
Laparotomy, median, 44.
Larynx, catheterization of, 4.
Leg, amputation through, 140.
Ligation of arteries, 80.
nerve, neurotomy of, 73.
Lisfranc's operation, 135.
Lister's operation, 144.
Liston's operation, 146.
Mammary gland, excision 'of, 43.
Maxilla, excision of superior, 109.
of inferior, 106.
Median nerve, suturing of, 74.
Metatarsus, amputation and disarticu-
lation of, 134.
Nasal duct, probing of, 4.
specula (Fraenkel), 1.
pollicis longus, tenotomy of, 68. Nepbrorrhaphy, 51.
Neurectomy of spinal accessory, 73.
Neurotomy of lingual, 73.
Nerve, stretching of great sciatic, 74.
suturing of median, 74.
Occipital artery, ligation of, 90.
Esophageal probang or bougie, 5.
Esophagotomy, external, 41.
Operations, steps in, 123.
Paraccntesis abdominis, 12.
Pedis, ligation of dorsalis, 100.
cystutomy, median, 57.
urethrotomy, external, 54.
Suprapubic cystotomy, 60.
Padial artery, ligation of, 80.
bones, articulating ends, 112.
Saw, manipulation of, 103.
nerve, great, stretching of, 74.
tenotomy of, 71,
nasal (Fraenkel), 1.
vaginal (Fergusson's, Sims's), 2.
Tarsus, amputation and disarticulation
of flexor carpi radialis, 69.
of tibialis posticus, 70.
anticus, tenotomy of, 70.