AMPUTATION.
In whatever part this is performed, the surgeon's object is the same, viz. to save enough of the surrounding soft parts to cover the extremity of the bone, and enough of skin to cover the whole. The stump is always treated as a wound which should be united by the first intention ; its sides are therefore brought together, and retained in apposition by straps of adhesive plaster, and appropriate banda ges. By this, which is the improved me thod of modern surgery, introdueed by Mr. Alanson of Liverpool, the wound made by removing a thigh is often agglu tinated in forty-eight hours, and the pa tient consequently escapes the dreadful pain and irritation, and vehement sympa thetic affection of the constitution, which almost invariably attended the old prac tice of dressing the stump with dry lint as an open wound, and consequently healing by means of granulation and cicatrization, instead of adhesion.
In amputation of the thigh, surgeons used to cut at once down to the bone, and saw that through ; but in order to save more soft parts, and thereby to avoid the pro jection of the bone, which commonly at tended that method, the double incision was devised ; by which the skin and mus. des are divided separately. More diffi culty is experienced here than in any other amputation, in saving muscles enough to cover the bone, which, in this particular instance, is especially desirable, from the pressure which the end of the stump must experience in supporting the weight of the body. The sound leg should be tied to the table, and the tourniquet ap plied on the inside of the thigh. The limb should be cut off as near to the knee as possible. A circular incision should then be made by the surgeon, standing on the outside of the limb, through the skin and adipous substance. The integu ments should be drawn upwards by an assistant, and any cellular connection that prevents their retraction should be divid ed. A cut should now be carried through the loose muscles, at the part to which the akin has been withdrawn, and when they have retracted, those which are fix ed to the bone should be divided at the roint to which the former had retracted.
The latter may be separated from the surface of the bone, for a short distance, by a common scalpel, to allow of the bone being sawed higher up than it could be otherwise. This part of the operation should follow, the surface of the wound being kept out of the way of the saw, by means of a retractor, which is a piece of linen, somewhat broader than the stump, torn at one end, in its middle part, to the extent of about eight or ten inches. It is applied by placing the exposed part of the bone in the slit, and drawing the ends of the linen upward on each side of the stump. Besides defending the surface of the wound from the teeth of the saw, the retractor will undoubtedly enable the operator to saw the bone higher up than he otherwise could do. The femoral ar tery should be drawn out by means of a pair of forceps, and tied separately; other large arteries should also be secured, without including any of the surrounding soft parts. Smaller branches must be taken up with the tenaculum. It is ne cessary to slacken the tourniquet, in or der to discover the vessels. The wound should then be thoroughly cleansed from all coagulated blood, by means of a soft sponge and water, and one end of each ligature removed. The skin and muscles are now to be placed over the bone, in such a direction that the wound shall ap pear only as a line across the face of the stump, with the angles at each side, from which the ligatures should be brought out. The skin is supported by long strips of adhesive plaster, applied at right an gles to the line of union of the wound ; the ligatures are guarded by lint spread with sperrnaceti-cerate ; and a linen roller is carried round from above downwards, two cross pieces having first been put over the end of the stump. The dressings should not be moved for four days.