A Modification of Wyeth’s 
Method of Bloodless 
Amputation at the 
Hip Joint. 
BY 
STEWART LeROY McCURDY, M. D., 
Dennison, Ohio, 
ProlesBor of Orthoptedic and Clinical Surgery, Ohio 
Medical University, Columbus, Ohio ; Lecturer 
on Topographical Anatomy and Landmarks, 
Western Pennsylvania Medical College, 
Pittsburgh, Pa.; Surgeon, P. C. C. 
and St. L. Ry. Co. 
REPRINTED FROM THE 
■\Teto York .fUeOicBl journal 
for May 7, 1892. Reprinted from the New York Medical Journal 
for May 7, 1892. 
A MODIFICATION OF 
WYETIFS METHOD OF BLOODLESS AMPUTATION 
AT THE HIP JOINT. 
By STEWART LeROY MoCURDY, M. D. 
DENNISON, OHIO, 
PROFESSOR OF ORTHOPAEDIC AND CLINICAL SURGERY, 
OHIO MEDICAL UNIVERSITY, COLUMBUS, OHIO ; 
LECTURER ON TOPOGRAPHICAL ANATOMY AND LANDMARKS, 
WESTERN PENNSYLVANIA MEDICAL COLLEGE, PITTSBURGH, PA. ; 
SURGEON, P. C. C. AND ST. L. RY. CO. 
The advance made in amputations at tLe hip joint, as 
suggested by Professor John A. Wyeth, must he considered 
one of the principal ones in modern operative surgery. The 
operation is described by Wyeth as follows: 
The patient being placed in position with the hip of the side 
to be operated on well over the corner of the table, the foot is 
elevated, and an Esmarch bandage applied to drive the con- 
tained blood toward the heart. The bandage should not be 
tightly put on over the seat of the disease for fear of driving 
septic matter into the circulation. With the rubber bandage 
still in position, the needles are next introduced. 
Two steel mattress needles, three sixteenths of an inch in 
diameter and a foot long, are used. The point of one is inserted 
an inch and a half below the anterior superior spine of the ilium 
and slightly to the inner side of this prominence, and is made to 
Copyright, 1892, by D. Appleton and Company., 2 
A MODIFICATION OF WYETH’S METHOD OF 
traverse the muscles and deep fascia, passing about half way be- 
tween the great trochanter and the iliac spine, external to the 
neck of the femur and through the substance of the tensor 
vaginae femoris, coming out just back of the trochanter. About 
four inches of the needle should be concealed by the tissues. 
The point of the second needle is entered an inch below the 
level of the crotch, internally to the saphenous opening, and 
passing through the adductors comes out about an inch and a 
half in front of the tuber ischii. No vessels are endangered by 
these needles. The points are protected by corks to prevent 
injury to the operator’s hands. 
A piece of strong, white rubber tube, half an inch in diame- 
ter and long enough when tightened in position to go five or 
six times around the thigh, is now wound very tight around 
and above the fixation needles and tied. 
The Esmarch bandage is removed, and five inches below the 
tourniquet a circular incision is made, and a cuif, which includes 
the subcutaneous tissues down to the deep fascia, is dissected off 
to the level of the lesser trochanter, at which level the muscles 
and vessels are divided squarely and the bone sawed through. 
All vessels (including the veins) which can be seen are tied with 
catgut, and the smaller bleeding points can be discovered by 
slightly loosening the tourniquet, which is then entirely removed. 
The remaining portion of the femur is now easily enucleated 
by dividing the attached muscles close to the bone and opening 
the capsule as soon as it is reached. . . . 
One other important point I wish to emphasize—viz., the 
advisability in certain cases of doing this operation in two sit- 
tings. 
In one of my cases the patient was greatly exhausted, and 
after dividing the femur at the lesser trochanter and securing 
the vessels, fearing the supervention of shock, as indicated by 
the pulse, I closed the wound, which healed by first intention. 
At the first dressing (on the seventeenth day), the remaining 
portion of the bone was removed by an incision over the tro- 
chanter major. The recovery was uninterrupted. 
I should prefer to complete the operation at one sitting, but 
cases will occur where the danger of shock may be obviated by BLOODLESS AMPUTATION AT THE II1P JOINT. 
3 
stopping short of enucleation, leaving this for a week or two 
when reaction and convalescence are assured. 
In neither of my cases was there any bleeding, and, in fact, 
amputation at the hip joint is now a bloodless operation. 
I have some hesitation in even presenting a modification 
of an operation devised by so eminent a surgeon, and one 
that has been so extensively used by surgeons throughout 
the country. It has occurred to me, however, that the dis- 
advantage of even having it necessary under extreme cir- 
cumstances to subject a patient to a second operation should 
he avoided if possible. 
Some have been content with what is known as Jordan’s 
operation, which is performed by making an incision from 
over the greater trochanter to the end of the stump and 
down to the bone. The head of the hone is then disarticu- 
lated and the soft parts are dissected from the trochanters 
and shaft down to a line with the lower edge of the flap. 
The head of the hone thus liberated is swung out so as to 
admit the assistant’s hand into the cavity, pressure being 
made internally upon the femoral with one hand and exter- 
nally with the other hand. With the assistant still at his 
task of controlling the vessels, the surgeon proceeds to make 
the flaps, ligate the femoral, etc. 
To perform this operation well, one must have a skillful, 
trusty, and, above all, muscular assistant. The task of con- 
trolling the femoral artery with the fingers while the hip 
joint is opened and the head and neck of the femur are 
dissected from the dense soft structures surrounding it, 
with the making of the flap and the ligating of the vessels, 
is, to say the least, trying. 
An effort has been made to combine what appears to 
be the advantages of both the above-described methods, 
and at the same time make tlm operation as bloodless as 4 
A MODIFICATION OF WYETH’S METHOD OF 
Wyeth’s and as rapid as Jordan’s. As is shown in the ac 
companying drawing, the Wyeth operation is so modified 
Fig. 1. 
as to be performed with but one needle instead of two, and 
always at one sitting. 
First draw a line from the most prominent point of the 
greater trochanter to the perinseum. The needle is entered 
on this line at a point just internal to the femur, and is 
passed directly through the thigh so as to make its exit just BLOODLESS AMPUTATION AT THE HIP JOINT. 
5 
below the tuber ischii. Passed through at this point the 
needle will be external to all the important blood-vessels, 
and the only haemorrhage possible will be from the smaller 
vessels upon the external aspect of the thigh. A figure of 8 
is now made by throwing a round rubber tourniquet around 
Fig. 2. 
the projecting ends of the needle, over the internal aspect 
of the thigh, sufficiently tight to destroy femoral pulsation 
beyond the tourniquet. The flaps are now made, which is 
followed by disarticulation. 
After ligating the blood-vessels, the cord and needle are 
removed and the stump is ready for final dressing. The 6 
AMPUTATION AT THE HIP JOINT. 
point of the needle should be guarded, as Wyeth suggests, 
with a cork. 
The second cut is prepared in view of carrying out the 
same idea of a bloodless amputation at the shoulder joint. 
The steps in such an operation are at once suggested to the 
surgeon, after having studied the rules laid down for the 
hip operation. REASONS WHY 
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