OCR Text |
Show 270 asirnmrron or THE THIGH. AMPUTATION or THE THIGH. In this amputation, it is of no consequence on which side the surgeon stands. The operative assistant ought to be 0p. posite to him. He may grasp the limb, but ought not to draw up the integuments during the first incision. The FIRST INCISION is to be made low in the thigh, but free of all diseased skin ; and, if possible, avoid cutting over a sinus J _ .,av . ‘i a, i. l , . ~.‘ . 1..M;m[«mgm or abscess. I have seen an amputation in which the matter spouted out on the first incision !--a bad suppurating stump of course followed. We may announce the general rule thus; if the inflamma tion has been of no peculiar kind, and be not at present active ; if it has left only a little thickening of the integuments, when the disease was not originally cutaneous, nor likely to become so, circumstances may occur to tempt us to make our incision in the thickened and somewhat inflamed integuments. I have seen no bad consequences follow the practice. 271 I. The arm is carried under the limb, till the knife reach almost round to the same side on which the operator stands. With one sweep penetrating to the fascia, the knife is brought round to the point where it first touched the skin. The meaning of this is, that the cut is more regularly done than by cutting first on one side and then the other; and the patient is saved some degree of pain, where the operation is most painful, in the cutting of the skin. During this incision, the assistant should not draw up the skin, else he will make it uncover; he should only steady and fix the integuments. 2. The large knife is laid aside, and with the scalpel the integuments are separated from the muscles and fascia, the assistant pulling the intcguments strongly upward at the same time. The integuments are then turned up thus :- To make the first circular incision, the knife is thus held-~ m mil-E «4»: ' r mom M099?" // .-.‘.._..._-1.‘x\~‘--¥' ~ 11'\u y W \ . \\ \X ff: \ \\ \\\\\\\ H \\ \\ \ W \\ , \\\\\\ \x~\A\\\ s\\\\ \ \ \‘rSs \\\\ / ‘ u, " _. . ...-_,__.....4_...aN-..-:--" \_\- a, 7', KW 3. The surgeon taking the amputating knife again in his hand, and placing it close to the inverted integuments, cuts down to the bone, and carries his knife" Toned With "n" "ml": as in the first instance |