Medical and Surgical Reports Volume 3 (Paperback)

This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1915 edition. Excerpt: ... Interposition of the Flap. The bones being temporarily restored to their normal relations, the original skin incision is extended backward from its upper end across the posterior surface of the arm (Fig. 88). The triangular skin flap thus outlined is raised, including a fair amount of subcutaneous fat, until the superficial surface of the triceps, or of the fat and fascia covering it, is fully exposed. An interposing flap of fat and fascia is then raised from the superficial surface of the triceps, with its base at the olecranon (Fig. 89). It is best to include some of the triceps aponeurosis and muscular fibers in this flap. The elbow joint is then partially dislocated again, and the flap is attached to the internal lateral ligament of the elbow, and to the anterior and posterior capsules of the joint, by a few interrjipted sutures of chrolnicized catgut (No. 0, ), thoroughly covering the articular surface of the humerus (Fig. 90). 5. Closure of the Wound. The forearm is restored to its normal relation with the arm, and the external condyle is brought up in front of the pedicle of the interposing flap, and is fixed to the humerus (Fig. 91). For this purpose I prefer Lambotte's self-boring screws; in the accompanying illustration a nail was employed because at the time (in the Laboratory of Operative Surgery) no such screws were at hand. I have also used chromic gut and phosphor-bronze wire sutures, but have found them inferior to the Lambotte screws in obtaining secure fixation. Two screws are better than one. If much bone has been removed from the humerus, it will be necessary to trim the external condyle to fit. The triceps is then sutured accurately to the brachioradialis and extensor muscles, the deep and superficial fasciae...