AMPUTATION AT THE SHOULDER JOINT. 



109 



boid and os calcis : an inferior flap is then made from the sole of the 

 foot. 



Fig. iO. 



Hey^s Operation. — The disarticulation is commenced immediately 

 behind the tuberosity of the fifth metatarsal bone ; separating the 

 fifth and fourth metatarsal bones from the cuboid, the third and se- 

 cond from the external and middle cuneiform bones. The internal 

 cuneiform is sawed through. The superior flap is made before the 

 disarticulation, and the inferior one subsequently. 



AMPUTATION OF THE GREAT TOE. 



The most convenient mode of removing 

 represented by dotted lines in this .figure, 

 inner side of the metatarsal bone, and 

 running round the joint obliquely, tak- 

 ing care not to wound the anterior ti- 

 bial artery. The flap is made from the 

 outer side of the toe. It will cover the 

 head of the metatarsal bone more per- 

 fectly, and can be more readily retained 

 in its position than any other. 



AMPUTATION AT THE SHOULDER JOINT. 



Hemorrhage is to be restrained by 

 pressure with the fingers, or the handleof 

 a key well padded, upon the subclavian 

 artery, as it passes over the first rib. 

 The flaps may be cut by transfixion, or 

 in the manner represented in fig. 42. The 

 external flap should be made first, out 

 of the deltoid, and then the head of the 

 bone disarticulated. The internal flap is 



this toe is by incisions 

 Commencing upon the 



Fig. 41. 



