The double-flap and circular amputations contrasted : being an abstract of a first prize essay at the University of Edinburgh / by F.N. MacHardy.

  • MacHardy, F.N.
Date:
1841
Catalogue details

Licence: Public Domain Mark

Credit: The double-flap and circular amputations contrasted : being an abstract of a first prize essay at the University of Edinburgh / by F.N. MacHardy. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Sir George Ballingall (1) has entered minutely into this sub- ject, and, ■with the united assistance of Sir John Robsin and Mr Russell, has come to the conclusion, that the exposed surface of the former will be rather double that of the latter, and this result, nevertheless, is based on the supposition that the length of each flap shall equal the breadth of its base. But to be regulated by such an inference, when operating at the lower third of the thigh, flaps of these dimensions would extend hclow the knee ! as will be at once apparent by consulting Vermalc’s plates, deli- neated in Memoircs de 1’Academic Royale de Chirurgie, Paris, 1753, t. 2, p. 215, fig. 14. By the circular incision, according to Plammick, (2) or Ijaw- rence, (3) in a limb 12 inches in circumference, the extremity of the bone shall have a covering half an inch thick, which, to- gether with 13 inches, the allowance for muscular retraction equals 2 inches, the rading of the circle; and in a flop, the length of which is the breadth of its base, under the same conditions, the cushion will be 2| in.; but 1| in. will be the covering given by an average flap of ordinary magnitude, the difference between the tr.ansverse and conjugate axes of the ellipse represented by the circle’s diameter. If 10 be the area of the circle, then, according to Sir George, 20 will be about that of the larger, and of course 15 that of the average or smaller flap, which last mentioned superficies will be even considerably below that allowed by Drs Tolefree (4) and Busche C5j, whose observations on this subject have, on the whole, been rather hypercritical. Then, since the ratio of tlic single division is to that of the double-flap as 10 to 15, much more will the former proportion be increased by the double circular incision, the truth of which has been well illustrated by Mr Liston in the second edition of his Elements of Surgery. But, the very nature of the flap incisions precludes the dire circular concomitants, — the lacerated surfaces, and angular- pouches, and just as more ready union is to be expected after the extirpation of tumours, &c. by elliptical tlian by circular (1) Mil. Surg. 2 Ed. p. 3G8. (2) On Amputation. (3) Ijcc- tures in Lancet for 1829-30, v. 2, p. 945. (.1) American Jour. Feb. 1824. (5) I.ancct, 1827-28, v. 2, p. 204.