CANCER. Ill 



The flap operation is sometimes performed. The arm being trans- 

 fixed, the anterior flap is made first ; the vessels are divided in the 

 posterior. 



Amputation at the elbow is performed by making a single flap 

 from the muscles and skin in front of the joint. The head of the 

 radius is disarticulated first : the ulna is then to be sawed, so as to 

 let the olecranon remain. 



AMPUTATION OF THE FORE-ARM. 



The tourniquet is applied to the brachial artery as in other opera- 

 tions upon this extremity. 



Two flaps are formed, one on the dorsal, the other on the palmar 

 aspect. These are best 



Fig. 44. 



are 

 made by transfixion and 

 cutting outwards. 



The amputation should 

 be performed as near the 

 wrist as circumstances will 

 admit of; although below 

 the middle it is not easy to 

 obtain sufficiency of flaps. 

 But, the general rule is, to 

 remove as little as possible 

 from the organs of prehen- 

 sion ; and operations are 

 attended with less risk to 

 life the farther they are 

 removed from the trunk. 



Amputation at the 

 Wrist. — The disarticula- 

 tion of the radio-carpal 

 joint is readily eflfected by 

 commencing at the styloid 

 process of the radius. A 

 dorsal and palmar flap is made of the skin, 

 to be allowed to remain. 



Amputation of the Fingers. — The hemorrhage may be con- 

 trolled by an assistant's grasping the wrist tightly. The finger may 

 be amputated at a joint or in the middle of a phalanx, though it is 

 important to save as much as possible. The operation may be circu- 

 lar, or with a flap, which should be made from the palmar aspect of 

 the finger. 



CANCER. 



Malignant diseases change the original structure of the part, 

 transform or destroy the surrounding tissues, travel in the course of 



The pisiform bone is 



