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Show 53341: AAII'CTATION BLLow Tm: ELBOW-JOINI. ,serUTATION AT THE snounnnn-Jomr. sufficiently to secure the main artery, freed from the radial nerve, and bury the end of the bone well in the flesh, no bad consequence can follow, but from some strongly prevailing CHAPTER 1X. evil tendency in the habit. AMI‘UI‘ATION OF THE FORE~ABM, BL‘LU\V THE ELI:0‘.V-JOINT. OF THE AMPUTATION AT THE SHOULDER-JOIN; "fur. amputation of the fore-arm below the joint is generallv done by the double circular incision. This attempt has a pceuliarly awkward effect in the hands of the young surgeon. I prefer making an incision of the nature of a double flap. When we grasp the fore-arm, we feel the sp'ne of the two bones running quite superficial ; and on the inner and outer sides of the arm, we feel the mass of tiesh of the two classes of muscles, the llexors and extensors. On these muscles must l'w‘fl‘h/ n tritium; mtg-ii .\_. s..-.. "-w- -‘ , A ‘ THE arm is amputated at the shoulder, in the case of gun-shot wound, with shattered bone and torn artery; or where both the axillary nerves and artery have been out. through; or where the caries of the humerus perpetuates a wasting disease (but this latter case will seldom occur) ; or, lastly, where the upper part of the arm has been bruised and we depend for covering the face of the radius and ulna; and flat, and the bones broken by a waggon-wheel, or machinery. we obtain more of them by making; a semicircular incision on Le Dran tells us, that before his time the method was to the inside of the arm (making a flap of the flexor muscles), and another meeting the first at the extremities of a gentle strike a strong curved needle through the flesh, on the inner and under part of the arm, about three fingers breadth be‘ low the arm-pit; to lay a compress on the part, and then to curve through the extensor muscles. By dissecting these two flaps up a little, and sawing the hone deep, we get a good mass of tiesh to cover them, and we have the advantage of retaining the skin in adhesion to the muscles. Four arteries w ill be tied-the radial and ulnar; and a lesser one on each side of the interosseous ligament. draw the ligature so as to include this compress. This secured the artery until the end of the operation ; when the head of the bone being separated from the scapula, the artery ras secured by the needle, and then the parts beyond, and the cord of nerves were cut through. Le Dran's incision was made in this manner. He made a cut across the middle of the deltoid muscle, a little below the , , pressing the sort parts against the extremities of the bones, until they are somewhat rounded by joint; an assistant raised up this flap, and the second incision went through the capsule. The assistant now turned out the absorption; and yet much of the success of the operation de« pends on the equable degree of support which i:- g‘iven to the head of the humerus, while the surgeon, usmg his finger oi stump. ther side, until the mere cord of vessels and nerves, and part of the skin on the lower side of the arm, was left. This part L- the left hand as a director, carried the incision down on ei~ was cut through last. of all, and the artery secured. More»! |