. Traitement postopératoire ; un épitomé de l'administration générale de soins postopératoires et le traitement des cas de chirurgie pratiquée par des chirurgiens américains et européens. v^très susceptibles de se déplacé de ses graves difficultés. intermalleolarposition causant (C) Un tibiotarsal Pirogoff ou amputation (Syme) à l'anklc-joint, même avec les résultats plus favorables, qui sont rarement assurée,nécessite un grand et lourd appareil à propos de la cheville, et, 47j 472 traitement postopératoire. En outre, donne rarement satisfaction ou de confort pour le porteur. C'est avec beaucoup d'amputations qui précède

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. Postoperative treatment; an epitome of the general management of postoperative care and treatment of surgical cases as practised by prominent American and European surgeons. v^ry liable to become displaced from its intermalleolarposition causing serious trouble. (C) A tibiotarsal amputation (Pirogoff or Syme) at the anklc-joint, even with the most favorable results, which are seldom secured, necessitates a large and cumbersome appliance about the ankle, and, 47i 472 POSTOPERATIVE TREATMENT. moreover, seldom gives comfort or satisfaction to the wearer. Withthe foregoing amputations it is many times mechanically impossible tosecure a satisfactory fit and adjustment for prosthetic apparatus. (D) In amputations oe the leg between the point of electionand the ankle it was observed and noted that the healing process waslong and stubborn, while a certain percentage of such cases absolutelyrefused to heal in a satisfactory manner. It was further noted thatalmost invariably the stump was extremely sensitive to heat, cold, andthe touch, and also subject to swelling, ulceration, and abscess. Itwas again noted that the patient usually elevated the stump to the highest. Fig. 169.—Chop art Amputation. Fig. 170.—Symes Amputationat Ankle-joint. position in sitting or reclining, the same procedure being followed bythose wearing artificial legs, thereby reducing the swelling and relievingthe throbbing, bursting, and painful feeling of the extremity. It wasinferred that these difficulties were the result of deficient circulation, and an anatomic investigation confirmed the theory and establishedthe fact. At about the middle of the mid-third and in the foot thecollateral circulation is found to be complete, but between these twopoints there is very little collateral circulation. It therefore followsthat the extremity of a stump made by amputating between these twopoints is practically devoid of circulation, the blood simply stagnating in COMPENSATIVE OR ARTIFICIAL AlIM.I AXCI S. 47

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