The principles and practice of modern surgery

by Roswell Park

Fig. 719

Bad stump, because posterior flap was cut too short, and there has been great retraction of all soft tissues. (Farabeuf.)

While patients may prefer disuse of a stump for as long a time as possible the judicious surgeon will prepare it as rapidly as he may for early application of the expected artificial limb. Inasmuch as leg stumps allowed to hang downward become cyanotic and edematous it is well to keep them bandaged, and the makers of artificial limbs prefer to have the bandages kept wet. When the stump is healed, passive motion of the remainder of the limb should be begun, in order that there may be a minimum of stiffening of joints. If, then, such a stump be bathed, massaged, moved, and then bandaged with comfortable snugness with cold, wet bandages, over which oiled silk may be fastened, and if this be done at least once each day, the stump will be prepared for the artificial limb, on the average, in two to three months. One should not wait for this expiration of time if it be thoroughly healed; or, on the other hand, he may have to wait much longer under unfortunate circumstances; but the above general principles of treatment and general statements will be found to prevail. [Figs. 718] and [719] illustrate the difference between good and bad stumps, while [Plates LIX] and [LX] (reproduced from Matas) furnish the surface outlines for selection of the various amputations of the lower limb.

CINEPLASTIC OR CINEMATIC AMPUTATIONS OF THE UPPER EXTREMITY.

The most pronounced and illustrative of recent methods is perhaps the “cinematic” or “cineplastic” procedure of Vanghetti. This Italian surgeon proposed a prosthetic method, in 1898, which is illustrated in [Figs. 720], [721] and [722]. He has shown that tendon terminations may be left exposed in stumps, under favorable conditions, and so utilized as to serve remarkably useful purposes—though under exceptional conditions. For a description of these methods the reader is referred to his monograph. (G. Vanghetti, Plastica e Protesi Cinematiche, Empoli, 1906.)

Fig. 720

Fig. 721