RETRACTION OF THE FLAP AFTER SYME'S AMPUTATION. By Surgeon-Major
John North,
Madras Light Cavalry. A note with the above heading, in the Lancet of the 3rd of February, calls to mind a stump I have lately seen, in which, however, the cicatrix is not drawn down to the bottom of the stamp, but the flap is drawn upwards and inwards. I append a rough drawing of the stump {posterior aspect) and a few ist
particulars of the case :? A. B., European, aged 15 years, female, met with an accident in England 9 years ago which necessitated soon afterwards
THE INDIAN MEDICAL GAZETTE.
i^o amputation
of the
stump and the
right
foot.
of
From the appearance of the of the limb (the boot the inches thick) I conclude
shortening girl has lately been wearing is 3% Byrne's amputation was performed. amount
Walking
on
the
stump having become
difficult and painful, her friends applied to the Garrison Surgeon, Surgeon H. F. DobI saw her son, m.ts. in consultation with him, and we made a cast of the stump. The above drawing is from the cast, and is faulty in that it does not make the end of the fibula (f) the most inferior part. The soft pad of the heel is drawn up and inwards, so that the sawn end of the fibula is incurved and bears all the pressure ; and now, in consequence, walking on the stump causes pain over the head of the fibula, which is displaced, and there is considerable enlargement of the corresponding part of the leg. As the limb is free from disease, it is decided to see first what the makers of artificial limbs in London can do to take the pressure off the end of the fibula and distribute it up the leg. In the meantime the patient is to discard the boot and use crutches. The unsatisfactory result in this case would suggest the question whether PirogofFs amputation is not better than Syme's where both are feasible ; at any rate in growing children. There is no reason to doubt that if the os calcis were sound and the former had been done with division of the been Tendo Achillis, there would have considerably less shortening of the limb, and a firm pad at the end of it not liable to shift. I performed PirogofFs amputation once for Madura-fungusfoot, and the result was so good that the patient, a big Telugu woman, walked with ease and comfort on the naked stump. Up-country, where septic influences need not be dreaded, comparatively no danger lies in exposure of cancellous bone. In the only two cases in which I have amputated through the knee?one being for extensive ulceration of the leg and the other for neglected aneurism of the posterior tibial,?no aftertroubles occurred, and excellent stumps with cicatrix well up obtaind by a long anterior flap, including the behind were patella sliced with the saw and brought up against the sawn end of the femur, the tendon of the quadriceps extensor being
divided.
Bangalore, 31st March, 1883.
[May, 1883.
John North,
Madras Light Cavalry. A note with the above heading, in the Lancet of the 3rd of February, calls to mind a stump I have lately seen, in which, however, the cicatrix is not drawn down to the bottom of the stamp, but the flap is drawn upwards and inwards. I append a rough drawing of the stump {posterior aspect) and a few ist
particulars of the case :? A. B., European, aged 15 years, female, met with an accident in England 9 years ago which necessitated soon afterwards
THE INDIAN MEDICAL GAZETTE.
i^o amputation
of the
stump and the
right
foot.
of
From the appearance of the of the limb (the boot the inches thick) I conclude
shortening girl has lately been wearing is 3% Byrne's amputation was performed. amount
Walking
on
the
stump having become
difficult and painful, her friends applied to the Garrison Surgeon, Surgeon H. F. DobI saw her son, m.ts. in consultation with him, and we made a cast of the stump. The above drawing is from the cast, and is faulty in that it does not make the end of the fibula (f) the most inferior part. The soft pad of the heel is drawn up and inwards, so that the sawn end of the fibula is incurved and bears all the pressure ; and now, in consequence, walking on the stump causes pain over the head of the fibula, which is displaced, and there is considerable enlargement of the corresponding part of the leg. As the limb is free from disease, it is decided to see first what the makers of artificial limbs in London can do to take the pressure off the end of the fibula and distribute it up the leg. In the meantime the patient is to discard the boot and use crutches. The unsatisfactory result in this case would suggest the question whether PirogofFs amputation is not better than Syme's where both are feasible ; at any rate in growing children. There is no reason to doubt that if the os calcis were sound and the former had been done with division of the been Tendo Achillis, there would have considerably less shortening of the limb, and a firm pad at the end of it not liable to shift. I performed PirogofFs amputation once for Madura-fungusfoot, and the result was so good that the patient, a big Telugu woman, walked with ease and comfort on the naked stump. Up-country, where septic influences need not be dreaded, comparatively no danger lies in exposure of cancellous bone. In the only two cases in which I have amputated through the knee?one being for extensive ulceration of the leg and the other for neglected aneurism of the posterior tibial,?no aftertroubles occurred, and excellent stumps with cicatrix well up obtaind by a long anterior flap, including the behind were patella sliced with the saw and brought up against the sawn end of the femur, the tendon of the quadriceps extensor being
divided.
Bangalore, 31st March, 1883.
[May, 1883.
