390 



ON AMPUTATION 



thigh, presents a remarkable combination of advantages. It is less serious in 

 its immediate effects upon the system, because a considerably smaller portion 

 of the body is removed, and also because, the limb being divided where it consists 

 of little else than skin, bone, and tendons, fewer blood-vessels are cut than when 

 the knife is carried through the highly vascular muscles of the thigh ; the 

 popliteal and one or two articular branches being, as a general rule, all that 

 require attention, so that loss of blood is much diminished. In the further 

 progress of the case the tendency to protrusion of the bone, which often causes 

 inconvenience in amputation in the thigh, is rendered comparatively slight by 

 the ample extent of the covering provided, and also by the circumstance that 

 the divided hamstrings slip up into their sheaths, so that the posterior muscles 

 have comparatively little power to produce retraction. The superiority of 

 the operation is equally conspicuous as regards the ultimate usefulness of the 

 stump, which from its great length has full command of the artificial limb, while 

 its extremity is well calculated for sustaining pressure, both on account of the 

 breadth of the cut surface of the bone divided through the condyles and from 

 the character of the skin habituated to similar treatment in kneeling. Consider- 

 ing, therefore, that this procedure can be substituted for amputation of the thigh 

 in the great majority of the cases both of injury and disease formerly supposed 

 to demand it, ' Garden's operation ' must be regarded as a great advance in 

 surgery. 



It is also of great value with reference to the general question of the best 

 mode of amputating in the lower limb. It confirms completely the conclusion 

 which was, indeed, obvious enough from theoretical considerations, that there 

 is no special virtue in the rectangular shape of the flaps advised by Mr. Teale, 

 but that the advantages claimed for his method may be attained by much more 

 simple means. 



Nevertheless to extend the method by anterior flap of skin alone to the 

 thigh and leg, as advised by Mr. Garden, does not seem to me judicious. A flap 

 of integument alone, sufficiently long to cover the entire diameter of the limb, 

 must be liable to the risk of sloughing ; and I cannot but think it wise, when 

 the muscular element is available for the purpose, to follow Mr. Teale's example 

 by including it in the composition of the flap. An operation thus intermediate 

 between those of Garden and Teale, with a rounded muscular anterior flap some- 

 what shorter than Teale's, and compensating for its diminished length and for 

 the absence of a posterior flap by retracting the muscles before applying the 

 saw, was practised in the thigh by Mr. Spence, of Edinburgh, before Mr. Garden 

 published, and yielded very good results.^ But this operation involves as high 



^ Edinburgh Monthly Journal, November 1859. 



