Outline of amputation of two fingers simultaneously with their metacarpals; also thumb with its metacarpal. (Modified from Mignon.)
Disarticulation at the Shoulder.
—Until accurate methods of blood control were introduced this was an amputation viewed usually with disfavor, in spite of the fact that compression of the axillary artery in theory is easy. The older methods comprised this compression, either above the clavicle, or by exposure of the vessel and its proximal ligation, or by opening and separating the joint and then seizing the vessels within the inner flap, and controlling them by digital pressure until their division. Now with the use of Wyeth’s pins and the elastic bandage, effectual control may be secured without resorting to any of the former expedients. If the removal is to be a high amputation, just below the neck of the humerus, the method shown in [Fig. 691], of application of the tourniquet and its control by a constricting strap, may be adopted.
If the surgeon expect to disarticulate he should resort to the pins of Wyeth (i. e., to the use of long mattress needles), which are passed through from above downward, or from the axilla upward, one of them being passed anteriorly and the other posteriorly, and brought out at corresponding points on the upper aspect of the shoulder, where, their points being protected by sterilized corks, they serve to prevent sliding of the elastic bandage or tourniquet, which is now placed proximally to them, and is thus held more securely than is possible in any other way.
PLATE LVII
Cutaneous Incisions in Amputations of the Upper Extremity (Ventral or Flexor Side).
1. Anterior oval or racquet incision for disarticulation of the shoulder by attacking the joint through the delto-pectoral groove (modified Spence’s operation).
2, 3. Circular amputation of lower and middle thirds of arm transformed into double square, antero-posterior flap operation by unilateral or bilateral vertical incisions.
4, 5, 6, 7. Circular amputation at various levels of forearm, including the disarticulation at elbow. In all of these, one or two lateral liberating incisions, cut down to the bone, may be required, on ulnar or radial side, or both, to permit easy retraction of solid musculo-tegumentary antero posterior flaps.