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Show AMPUIATION or In}: mien. .AMPUTATION BELOW THE KNEE. Until the third day from the operation, we have nothing to do but to consult the feelings of the patient. Some uneasin ness must be expected; but unless there be twitching, or spasm, or much restlessness, 1 should avoid repeated opiates. CHAPTER VII. There may be. tightness of the dressings, and pain from the binding, which may induce us to remove a few turns on the roller, or ease the ends of the cross bandage on the face of the stump, or there may be an oozing, which may cause us to draw them a little tighter, or to keep the pupil in waiting more narrowly on the watch ; but ten to one that nothing of this kind w ill be necessary until the third day. But even on the third day I would not take off the intire dressings, nor apply a poultice to soak the dressing. Let the roller be undone, and the compresses be taken off, so that K‘IRST OF THE COMMON OPERATION BY THE CIRCULAR IXCISIOX. the degree of redness in the flaps is seen ; but if all is right, A FE‘V INCHES BELO‘V' THE KNEE. AMPUTATION OF THE LEG BELOW THE KNEE. no unusual softness, no great degree of tension and swelling, 44mm ,. ».. ‘5 and drawing of the integuments upon the adhesive straps, the further exposure of the wound is unnecesvh»sary. The dressing s may be put. on again with somewhat of a slighter degree of -: om pression. The dressing on the fifth day should be complrte: every thing ma y be now removed. If the moisture of the wound, and the snppnration has not, been sutticient to soften and loosen the dressing, a large poultiee may be put on for an hour, after which the dressings come easily off. "hen the stump is exposed, we expect to find the integll- . Jun" .0, A r truth"! 276 anE change necessary in the apparatus, is only the addition of a catiline knife, the adaptation of the dressmgs to a smaller stump, and the retractors slit so as to form a slip for . . passing betwixt the tibia and fibula. The tourniquet is now to be placed a httle above the knee, with the pad or the compress betwixt the ham-string ten. dons. the last opera in as The patient and assistants are placed tion ; but the surgeon stands on the inside of the knee. msnts adhering to the parts below, and, perhaps, in part, at their edges. we feel and press gently on the integuments, that no collections of 111atter may lodge under them. If mat- 1. The circular incision of the integuments is made, (about two hands' breadth below the patella) and the skin folded back, and separated from the. tibia and the muscles on the ter has be '11 collecting, we put a soft compress over it, so that when the bandage is put on, the sides of the little cavity may be kept in Contact. The adhesive straps are now put 011, 50 back part. 2. Unless the calf of the leror be very fleshy, a large scalpel as to cover the integuments where they were left bare in the will serve to make the second circular incision ; or the catihne may be rather used, by which means both the circular inci- first dressing. k sion around the bones, and the cutting of the interosseous liga- .l‘pe dressing of the stump is, after this, a daily duty: and, on the fifth dressing, we may gently solicit the ligatu t‘es from the lesser arteries. ‘ saw, may ment, and the notching of the periosteum for the interrupbe done with the same knife, and of course, with less tion. it new Massif i |