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Show 236 AJII'UTA‘IION AT THE SHOULDER~JOIN'I. AMPUTATION AT THE SHOULDER-JOINT. Others have performed the operation in this manner (La Faye)- 28; divide these vessels at a considerable distance below the ligature, and pursue the circular incision through the joint, cutting "first into that part of the bursa] ligament which is nearest to the axilla : for if you attempt to make way into the joint, on the upper part of the shoulder, the projection of the processus acromion and processus coracoides, will very much embarrass, if not baflle the operation." The next method to be mentioned, is that of Bromfield. He, I believe, was too partial to the operation. He drew an incision from the point at which the pectoral muscle is inserted, to the opposite point in the back of the arm, and a second incision from the point. of the acromion to meet it. " ‘ {life "" ~ , warm" m » titanium rum-Ii 3 "1‘, , ll Willi; Then he dissects back the inner flap, until he lays open the vessels. He then ties ‘the artery and the vein also ; and, finally, he turns out the head of the bone, and cuts across the remaining portion of the skin on the lower part. it new Maser! Making the incision, A, across the shoul der, a little further down than in the last instance, two incisions, B, E, are carried down to it, in the direction of the fibres of the deltoid, from the top of the shoulder, so as to convert the massy part of the deltoid muscle into a flap. Sharpe performed the operation in this mann er, (as in figure 2.) " The patient being laid on his back, with his shoulder over the edge of the table, make an incis ion through the membrana adipose, from the shoulder acros s the pectoral muscle, down to the arm~pit ; and in order to save as much skin as possible, begin it about two inches below the joint; then turning the knife with its edge upwards, divide that muscle, and part of the deltoid, all which may be done Without danger of wounding the great vessels, which will beco me exposed by these openings ; if they be not, out still more of the deltoid muscle, and carry the arm backward: then with a strong ligature, having tied the artery and vein, caref ully Thus, then, stands Bromfield's operation (iig. 1.). But the "he best method will, I conceive. be the following (tie. 2.}. |