248 



APPLIED ANATOMY. 



just below the posterior portion of the acromion process (its angle) then passing 

 under the acromion to emerge in front at the coracoid process. This flap was turned 

 up, the capsule and muscles divided, the bone turned out, and while an assistant 

 compressed the remaining tissues they were divided transversely. 



Lisfranc 1 s method consisted in transfixing the posterior axillary fold from below 

 upward, entering the knife in front of the tendons of the latissimus dorsi and teres 

 major muscles and bringing it out a little in front of the acromion. The joint 

 was opened posteriorly, the bone luxated, and an anterior flap cut from within out- 

 ward. Sir William Fergusson, probably the most skilful operator of his day, was 

 partial to this operation. 



The Racket Method. In this method the incision resembles in shape the 



Long Aero- 

 head of mion 

 biceps process 



Deltoid 

 muscle 



Supraspinatus 



Deltoid 



Coracoid 

 process 



Pectoral is. 

 major 



Coracobrachialis and " 

 short head of biceps 



Musculocutaneous 

 nerve 

 Median nerve 



Internal cutaneous nerve 



Musculospiral 

 (radial) nerve 



Infraspinatus 



Teres minor 



Long head of 

 triceps 



Circumflex nerve 



Posterior circumflex 

 artery 



Subscapular artery 

 Latissimus dorsi and 

 teres major 

 Ulnar nerve 



FIG. 263. Amputation of the shoulder by anteroposterior flaps. The upper extremity of the incision passes 

 between the coracoid and acromion processes. The posterior flap is the larger. 



ordinary racket, such as is used in tennis. The loop encircles the arm, while the 

 handle begins above at the point of the shoulder. 



There are two operations by the racket method, which differ as to the position 

 from which the upper portion of the incision starts. 



Larrey* s Method. The operation usually ascribed to Larrey consists in starting 

 the incision at the anterior end of the acromion process and continuing it straight 

 down the arm for three centimetres (i^ in. ). It then parts, one branch sweeping 

 gradually in a curved line to the anterior axillary fold and the other to the posterior 

 axillary fold, an incision, through the skin only, passes across the inner surface of the 

 arm joining the two branches. The flaps having been turned anteriorly and poste- 

 riorly, the joint is opened by cutting on the head of the bone, first posteriorly, then 

 above, and then anteriorly. Tilting the head outward the inferior portion of the 

 capsule is divided and the bone loosened from the soft parts. These are com- 

 pressed by the fingers of an assistant and cut. 



