Page 24

Printed for Joel M. Hawkins u nion by first intention or by the a dhesion of the gr a nulating sur faces. the vascular connections of the flaps ar e not distur bed, and their nutr ition is ther efor e mor e per fect than in the case of a cuff or flaps of integument only. the end of the bone is deeply bur ied betw een the flaps, but it does not pr ess upon them, for it is protected by the projection beyond it of the deep muscular fibr es. the stump bears neglect and bad usage dur ing the after-tr eatment r em ar k a bly w ell, and w ill gener a lly tur n out w ell even in the

he cicatr ix and cause a painful or tender stump. the double-flap

ation may be per for med w ith near ly equal facility in all con-

ons of the tissues, from the . state of per fect hea lth, as in

ary a mputation for sudden injury, to the fir m consolidation

he parts w hich r esults from the effusion and organization of

a mmatory products. in the latter class of cases, ther efor e, it

rs m ater i a l a dva ntages ov er a n y of the a pprov ed circula r

hods, both in ease and r apidity of per for mance and in the per-

san fr ancisco, usa should then be divided, the r etr actor applied, and the femur saw n

sweep of the knife. the attachments of the bone at the linea asper a

and the section of the soft parts is completed by a single circular

wher e the bone is to be saw n. after cutting the flap it is lifted up,

it should somew hat exceed the dia meter of the limb at the point

the whole cut surface without stretching; in length and in breadth

over the face of the stump, and it must be large enough to cover

flap should be cut r ather thin, in or der that it may be easily bent

either by tr a nsfixion or by cutting from w ithout in wa r ds. the

hands of a very unskillful dr esser. the oper ation may be per for med

in the for m gi v en to the cov er ing of integument, by w hich

from the common circular method; the chief differ ence cons

per for med in this man ner, does not differ mater ially in pr inc

aided by str ips of adhesive plaster. the single-flap oper ation, w

the end of the stump and r etained in its place by a few sutu

stump. in dr essing the wound, the flap should be folded neatly

of secondary hemorrhaging, or, in the latter, of a painful or te

thickness of the flap, else ther e w ill be danger, in the for mer c

must be ta k en not to i nclude a n y la rge v essel or nerv e i n

an inch or two above the tr ansverse section of the muscles. c


to the ex act coaptation of the soft parts, w hether w e hope for


fection of the immediate r esult. the for m of the wound is favor able

SOURCE Âť a mfa portfolio

flap ; if this happens to be the case, it should be dr aw n out of


heath and divided as high as possible, lest it become engaged



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