Case of successful amputation at the hip-joint on account of malignant tumour of the femur / by James Spence.

  • Spence, James, 1812-1882.
Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: Case of successful amputation at the hip-joint on account of malignant tumour of the femur / by James Spence. Source: Wellcome Collection.

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    and dividing the posterior parts almost directly backwards; but as examination shows that even at an early period the muscles near the diseased bone are liable to be affected, it is of vital importance to plan our operations to avoid proximity to the tumour, so as to diminish the risk of retaining any morbid tissue in the flaps. Hence I prefer two shorter flaps to one very long one, as it must encroach more on the altered parts by its greater length. Eapidity of execution in this operation is of great importance, as diminishing the risk from loss of blood; and in cases of tumours where we have the leverage of the whole limb, the disarticulation may be accom¬ plished in from ten to twenty seconds. The chief tilings to be attended to for its rapid performance are,—attention to the position of the patient; that the hip projects well over the table, whilst the pelvis is kept firmly secured, so as to prevent the body receding: this allows the limb to be fully depressed after the anterior flap is formed, and also facilitates the other movements necessary for enabling the knife to be passed readily beyond the trochanter major, so as to cut the posterior flap. The direction given to the knife in passing it across the front of the limb to form the anterior flap is all- important as to the ease with which the subsequent steps will be accomplished. In operating on the right thigh, the surgeon, standing on the inside of the limb, which must be abducted, and slightly flexed on the pelvis, should enter the knife immediately in front of the tuber ischii, and carry it steadily in an oblique direction across the front of the joint to a point .nearly midway between the great trochanter and crest of the ilium. In doing this great care must be taken to make the knife pass close in front of the head of the femur, so that when the flap is formed and raised, the capsule will be found to be opened, and when the limb is forcibly depressed the head of the femur either at once starts out, or a single cut upon it divides the remaining portion of the capsular and round liga¬ ments, and nothing remains to be done but to clear the trochanter major, and form the posterior flap. In this case the common femoral artery was commanded by manual pressure, and the vessels on the posterior flap by a large sponge firmly applied the instant the limb was severed. The abdominal aorta could have been readily com¬ pressed if required; but, as I have found in other cases, the means above mentioned were quite sufficient, and less blood was lost than in an ordinary amputation of the thigh. In this as in other successful cases I have recorded, the femoral vein was tied to arrest bleeding, and I believe, as I have stated elsewhere, that instead of being hurtful it seems rather to do good, by preventing pus or unhealthy discharge entering the venous circulation by the large open mouth of the vein kept patent as it is by its fascial connexions. The progress of the case as given in the report shows how much success in such operations depends on careful after-treatment, watchfulness of symptoms, and persistence in appropriate remedial measures, even when the condition of the patient seems very hopeless.