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
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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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    and of Richter, (1) the other operation appears to possess many disadvantages in formation, cure, and ultimate recovery, scarcely applicable to the flap, which so often successfully baflles with debilitated patients and ill-conditioned limbs. Analogous to those cases of extensive burns on the neck, where the cure was deemed complete, yet the chin left bridled to the breast, ai'e the instances of circular amputations of the thigh, condemned to the Cripplegate Workhouse, for twenty years under the superintendence of Mr LanfistafF, (2) in whose museum relics yet remain, emblems of unphilosophic surgeiy—of unphi- losophic men ! Fourth, Experienced surgeons have not always agreed as to the proper part to be selected in amputating the leg, which has been removed by Gutherie (3) at the calf; Bransby Cooper, (4) Key, (5) and Travers, (6) 4 inches below the patella; and by Syme (7) close to the tuberosity of the tibia. Abernethy (8) and Richerand (9) have recommended the leg to be removed 4 inches below the knee, as it gives convenience, and preserves the mo- tion of the stump, which has been denominated by Cooper “ the point of election.” Those who can afibrd an elegant artificial limb, may safely have a longer stump; but in the lower ranks of society, the patients are solicitous of a shorter ; (10) and prudence is here requisite, in case the tibial arteries are divided as they branch from the popliteal, * * above the superior fibres of the soleus muscle; and in case the capsule of the knee joint be en- tered, as frequently in old people it communicates with the tibia- fibular articulation, (11) from which it would appear, that the excision of the caput tibialis, as practised by Larrey, (12) and (1) Edin. Med. and Surg. Jour. 1821, v. 21, p, 33. (2) Lond. Med. Chir. Trans, v. 16. (3) Gun-shot wounds, 3d Edit. p. 305. (4) Lancet, 1825, v. 7, p. 169. (5) Ibid. v. 6, p. 219. (6) Ibid. p. 158. (7) Edin. Med. and Surg. Jour. v. 22, p. 5l. (8) Lancet, 1826, v. 2, p. 276. (9) Nosograph. Chir. t. 4, 510. (10) Surg. Diet. 7th Edit. p. 71. (11) Lancet, 1826, v. 3 and 4, p. 47. (12) Monro on Bursoe mucosfe, 1788, p. 25. * A case came under the observation of the writer, where double secondary hemorrhage was occasioned by the non-coagu- lation of the blood from this cause ; the high division of the limb being only made at the solicitous entreaty of the patient.