Amputation of Fingers and Toes

 

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[See Also: Civil War Medicine, Amputation Overview, Amputation of the Leg, Amputation Below the Knee, Amputation of the Arm, Amputation of Fingers and Toes]

Amputation: Amputation of Toes and Fingers

(From "The Practice of Surgery", by Samuel Cooper, and notes by Dr. Alexander H. Stevens. This book served as the "How To" guide for Civil War surgeons)

 

AMPUTATION OF THE FINGERS AND TOES.

The operation may be done in various ways. Sometimes a small semilunar incision is made on the back of the finger or toe to be amputated, extending across the part with its greatest convexity about half an inch beyond the joint. The Rap is next raised, and reflected. The skin on the other side directly opposite the joint, is divided by a second cut, extending across the finger, or toe, and meeting the two ends of the first semilunar incision. The joint is now bent, and the capsular ligament opened. One of the lateral ligaments is then divided, which allows the head of the bone to be dislocated, and the surgeon has nothing more to do, than to cut such other parts, as still attach the part, about to be removed, to the rest of the limb. When the arteries bleed profusely, they must be tied; but, in general, the hemorrhage will stop without a ligature, as soon as the flap is applied to the end of the stump, and the edges of the wound have been brought together with adhesive plaster. Of the plan of stopping the bleeding by pinching the vessels, sometimes recommended, I can say nothing from my own experience.

The Smaller Bone Saw in the Photograph Would Be Used for Amputation of Fingers and Toes

Lisfranc amputates the second or third phalanx of a finger in the following manner: he bends it, and observes the small lateral fissure in the integuments, directly behind the joint. Here the first incision is made, which lays open the point, by dividing the integuments and ligaments on the sides and dorsum of the finger, from left, to right. In cutting the ligaments at the sides, the edge of the bistoury is directed towards the end of the finger; but, in cutting those on the dorsal side of the joint, it is turned in the opposite direction. The under portion of the capsular ligament is then cut through, and, with the knife directed horizontally, a sufficient flap is made by cutting between the integuments and bone. When the part cannot be bent, Lisfranc first forms a flap on the palmar side of the finger, by pushing a bistoury through it under the integuments, and cutting forwards and outwards: the operation is then finished nearly in the way of the flap-operation sometimes performed in England, and already described.

Some surgeons, who consider it unnecessary to make a flap, draw the integuments a little up, and then divide them in a circular manner. When the integuments are not diseased, quite enough of them may thus be preserved for covering the bone.

In amputating the metacarpal bone of the thumb, the surgeon should place it in the state of abduction, and make an incision at the mid-point between it and the metacarpal bone of the fore-finger. The cut is to be continued down, until the knife touches the os trapezium, when its point is to be turned towards the joint, and the capsular ligament opened. The knife is to be carried through the joint, the head of the bone pressed towards the hand, and a flap formed at the side of the bone, by cutting in the direction away from the trapezium.

A formal dissection of the metacarpal bones of the fingers, away from their articular connexion with the carpus, is now rarely performed, because they may always be easily cut through at any point with Mr. Liston's bone-nippers.

Bone Nippers

Bone Nippers Were used to Remove Splinters after Sawing, or in the Case of Amputation of Fingers and Toes, could be used to Snip off the Affected Appendage

When it is necessary to remove the metatarsal bone of the great or little toe, it is better to saw off the diseased portion, than to cut into the joints of the tarsus. Sufficient skin should be saved for covering the bone, and when the saw is used, the adjoining soft parts must be defended from injury by a piece of pasteboard, placed between them and the teeth of the instrument. The division of the bone may also be very conveniently performed with Mr. Liston's bone-nippers.

 

 

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