A Manual of the Operations of Surgery, page 69 by Joseph Bell
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. The resulting wound is almost perfectly ovoid, the flaps come together with great ease in a straight vertical line, which admits of easy and thorough drainage. Union is generally rapid. Larrey's success by this method was very remarkable: ninety out of a hundred cases in military practice were saved, notwithstanding the well-known risks of such operations.
#2.# As good as the former, and nearly as universally applicable, is the method devised by Professor Spence, and practised by him in nearly every case:--"With a broad strong bistoury I cut down upon the inner aspect of the head of the humerus, immediately external to the coracoid process, and carry the incision down through the clavicular fibres of the deltoid and pectoralis major muscles till I reach the humeral attachment of the latter muscle, which I divide. I then with a gentle curve carry my incision across and fairly through the lower fibres of the deltoid towards, but not through, the posterior border of the axilla. Unless the textures be much torn, I next mark out the line of the lower part of the inner section by carrying an incision through the skin and fat only, from the point where my straight incision terminated, across the inside of the arm to meet the incision at the outer part. This insures accuracy in the line of union, but is not essential. If the fibres of the deltoid have been thoroughly divided in the line of incision, the flap so marked out, along with the posterior circumflex trunk, which enters its deep surface, can be easily separated from the bone and joint, and drawn upwards and backwards so as to expose the head and tuberosities, by the point of the finger without further use of the knife. The tendinous insertions of the capsular muscles, the long head of the biceps, and the capsule, are next divided by cutting directly upon the tuberosities and head of the bone; and the broad subscapular tendon especially, being very fully exposed by the incision, can be much more easily and completely divided than in the double-fl