AMPUTATION OF THE THIGH. 105 



according to the state of the circulation. It often grows rapidly, and 

 brings h'ie into imminent peril. 



Its removal may require the knife, excision or compression. 



AMPUTATION. 



Amputation is not to be resorted to until all other means of cure 

 have failed. In cases of gangrene, large malignant tumours involv- 

 ing a bone or a joint, diseases of the joints causing hectic and 

 threatening life ; m case of recent injury, where reparation is im- 

 possible, then amputation must be performed. 



In case of injury, amputation is either primary or secondary; 



Primary ; when performed immediately after the patient has re- 

 covered from the shock of the injury, and before febrile excitement. 



Secondary ; after suppuration has commenced, and perhaps 

 sloughing. Secondary amputations are also performed for diseases 

 of the bones or joints. 



Primary amputations are to be performed when it is impossible to 

 save the injured limb. In military life, limbs are amputated for in- 

 juries, which a surgeon might attempt to save in civil life ; there 

 bemg less opportunity for treatment, and less favourable opportunity 

 lor secondary amputation. 



Instruments and i)rmj/zg5.— Amputating knives, Catlin's saw, 

 tourniquets, scalpels, tenacula, forceps, needles, ligatures, sponges, 

 bone-nippers, compresses, rollers, retractors, lint spread with cerate, 

 charpie, adhesive strips, and warm water. 



AMPUTATION OF THE THIGH. 



^ The patient having been brought to the edge of the bed, his back 

 IS supported by pillows, and his hands held by assistants. The 

 tourniquet is applied over the superficial portion of the artery, about 

 three mches below the groin, so as to interrupt the circulation of 

 blood m the limb. This, like other amputations, may be performed 

 in two ways, either by the circular incision or by the flap operation. 

 Circidar Incision. —The surgeon stands so that he may use his 

 left hand to grasp the part which he is to amputate, the leg being 

 firmly supported, in a horizontal position, by an assistant ; the sur- 

 geon then carries the amputating knife under the limb, and with one 

 complete sweep round the limb, divides the skin, fat, and fliscia. A 

 scalpel IS then used to dissect the integuments from the muscles, in 

 order that they may be turned up, for two inches, in the same way 

 that one would turn up the cuff of a coat. With the amputatino- 

 knife, the muscles are now cut through down to the bone, the edo-e 

 of the knife being inclined upwards, in order that the stump may 

 present somewhat of a conoidal cavity ; the muscles are to be slightly 

 separated from the bone, and a retractor applied to pull them up- 

 wards. In using the saw, the heel should first be applied on the 



