FRACTURES OF TEE BONES. 299 



always be cut in such a manner as to cover the stump when the two ends 

 or flaps are united. All the vessels, arteries as well as veins, which have 

 been cut must be taken up separately with the forceps and ligated with cat- 

 gut or silk. All stumps of nerves which lie loose upon the wound are to 

 be drawn out with the forceps and cut off as close as possible. The ban- 

 dage must not be removed until all the bloodvessels have been ligated (Fig. 

 67). The wound and its neighborhood are then thoroughly irrigated with an 

 antiseptic solution and closed with stitches ; the skin is also stitched at the 

 same time. The different forms of stitching are illustrated on page 314. 

 The whole wound is to be covered with a permanent antiseptic dressing. 

 (For further detaiils, see Treatment of Wounds.) 



Amputation by means of a Cireular Section. Cut through the skin of the 

 affected extremity to the fascia, making a complete circle around the mem- 

 ber. Pull this back and have it held by an assistant, he pulling the skin 

 toward the body as far as possible. It may be necessary to dissect the skin 

 and the cellular tissue from the under layer of the skin. After that make 

 a sharp, clean cut, entirely circular, close to the edge of the skin which is 

 pulled back, amputating all the muscles, and finally cut with bone forceps 

 (Fig. 66, b, page 296), or saw through the bone. While cutting through the 

 bone it is necessary for the assistant to pull back the soft tissues as far as he 

 possibly can toward the body, either with his hands or by means of a linen 

 compress which has been dipped into an antiseptic solution. In cases where 

 amputation of the extremities has to be performed, where there are two 

 bones, as in the forearm, it is necessary to cut the soft tissues which are 

 located between the bones. 



Flap Amputation. We cut two half-moon-shaped flaps of the skin and 

 separate them from the fasciae in which they are located as far as their 

 base,- turning them upward and backward. The muscles are cut close to 

 the flaps, the tissues pulled back, and the bones sawed through. 



Amputation of the tail. 



Exariiculation. Separate the soft parts exactly as in amputation by means 

 of a circular or flap cut. We then open the affected joint by bending it, 



