make equal anterior & posterior skin flaps (fish mouth incision)
length of each flap is about ½ the diameter of the forearm at the level of the amputation
apex of the fish mouth is proximal at about the level of bone resection
reflect skin, sub cut tissue & deep fascia proximally to level of bone resection
clamp & ligate the ulnar & radial arteries just proximal to this level
identify the 3 nerves, draw them gently distally & transect them high so they will retract
cut across muscle bellies transversely distal to the level of bone section & allow the ends to retract
divide the radius & ulna transversely, rasp sharp edges
close deep fascia, then skin flaps with interrupted non-absorbable suture
insert drain deep to the fascia
can also carry out myoplastic closure with this amputation by making a FDS muscle flap that’s long enough to be carried around the end of the bones to the dorsal deep fascia
