AMPUTATIONS 271 



muscles spontaneously retreat, and the superior stump is drawn 

 upward beyond the cutaneous incision. This action may be facU- 

 itated by separating from the bone whatever attachments may 

 exist between them. The periosteum is thus divided, on a level 

 with the retracted muscles. 



The amputation in the contiguity of the bones, differs from 

 that in the continuity only in the fact that when the section of the 

 muscles is made, there is no division of the periosteum necessary, 

 and the disarticulation is completed with either the bistoiu-y or 

 amputating knife, or, in preference, with the sage knife. The 

 method hy flaps consists in making on one or both sides of the 

 bones, one or two flaps of skin which are afterwards united to 

 cover the stump, and form the new surface. 



In amputation by the contiguity of the bone, the method to 

 be pre'ferred, and which may be practiced both from within, out- 

 ward and contrarywise, is this : In the first instance, the knife is 

 passed through the soft tissues at the point where the bone is to 

 be separated, and the entire mass divided by drawing the instru- 

 ment toward the operator in a somewhat oblique direction. In 

 the second way, or from without inward, the flap is first drawn 

 with the point of the knife, and then dissected from without, or, 

 otherwise, made at once in the same direction, by one stroke of 

 the instrument. The flaps must be rounded, not angular, at their 

 line of meeting, and in such a way that the amputated wound 

 will represent an elliptic inf undibulum, whose center is occupied by 

 the stump of the bone, surrounded by whatever projecting fleshy 

 structures may be brought over it to form a protective cushion. 



The second step of the operation is that of the section of the 

 bone, or of the articular' attachments. 



In sawing the bone in its continuity, the periosteum being 

 divided, and the soft tissues protected by compresses, some little 

 art is necessary. The saw applied perpendicularly to the axis of 

 the bone, should be worked slowly at first, until a track is formed, 

 after which the movement may be more rapid. Pressure upon 

 the instrument is unnecessary, if it has been properly set. Special 

 caution should be observed in finishing, in order to avoid leaving 

 rough edges to be cut off with the bone forceps. The saw must 

 be propelled wholly by the action of the arm of the surgeon, his 

 body remaining completely motionless. 



"When the amputation is made upon the segment of a leg 



