IO4 Anatomy Applied to Medicine and Surgery. 



divided subcutaneously or by the open method. In am- 

 putation through the second and third phalanges it is ad- 

 visable to close. the synovial sheath, since, if this be not 

 done, there is left an open channel to carry upwards septic 

 infection, should any develop. 



In wounds of the palmar arch, ligate the vessel, even if 

 the hemorrage be from the deep arch. The older treat- 

 ment was to employ the graduated compress, a dangerous 

 procedure, since, in the case of the deep arch, it would be 

 almost impossible to compress the vessel on account of its 

 depth and because of the resistance offered by the palmar 

 fascia, hence, the attempt to use the compress might re- 

 sult in gangrene of the tissues of the hand. If the com- 

 press failed, then the ulnar and radial were ligitated, and 

 if this did not check the hemorrhage generally the case, 

 since the circulation would still be carried on by the in- 

 terosseous above, anastomosing with the carpal arches be- 

 low, and by the median above, communicating with the 

 branches of the superficial arches below then the bra- 

 chial was ligitated. If this failed, the hand was amputa- 

 ted another harsh procedure, to say the least. In these 

 days of asepsis there need be no fear of opening up the 

 synovial cavities in the palm, hence, in the case of a wound 

 of the superficial arch, make a vertical incision and expose 

 the wounded vessel and ligate. In the case of the deep arch 

 a more extensive incision will be required an incision 

 reaching from the web of the finger, in a line with the in- 

 jury, to above the carpus, dividing the palmar fascia and 

 drawing aside the flexor tendons until the wounded vessel 

 is exposed. 



Excision of the wrist is indicated especially in tuber- 

 culosis of the joint and may be performed through a pos- 

 terior, and, if necessary, an ulnar incision. In making 

 the posterior incision two landmarks are taken : One, the 



