Commentaries on the Surgery of the War in Portugal, Spain, France, and the Netherlands / from the battle of Roliça, in 1808, to that of Waterloo, in 1815; with additions relating to those in the Crimea in 1854-55, showing the improvements made during and since that period in the great art and science of surgery on all the subjects to which they relate.

by G. J. Guthrie

a a a, anterior flap in dotted lines;
c, thumb compressing the artery on the pubis;
d, fingers introduced under the flap;
e, the straight knife, entrance and exit of.

(Lower figure.)

Flap Amputation as performed by Mr. Luke, on the lower half of the thigh.

A, middle of the outside of the thigh and point of entrance of knife;
B, under part;
C, upper part;
A to E, the under flap;
G to F, dotted line of upper flap, beginning short of commencement of under flap.

The assistant holding up the flap, the surgeon cuts the attachment of the gluteus medius muscle, from the upper edge of the trochanter, if it has not been already done, opens the capsular ligament of the joint, and divides the ligamentum teres. The head of the bone can then be readily withdrawn from the acetabulum. The knife being placed behind the head of the bone and the trochanter, should be carried obliquely downward and backward, so as to form a shorter flap behind than was made before. The amputations of the hip-joint, performed in the Crimea, have not, I understand, been as successful as the ability with which they were performed might have led the operators to expect.

Fig. 2.

Mr. Guthrie’s operation.

Left side—
a, anterior superior spine of ilium;
b, commencement of anterior incision, continued by the black line;
c, the posterior incision joining the anterior one.