A manual of operative surgery . he limb. It terminates as avertical cut opposite the centre of theinterarticular line. A second incision begins at the samepoint on the front of the limb as thefirst, and pursues a similar directionacross the inner side of the leg, meetingthe first incision at the median line uponthe posterior aspect of the inner flap should be a little fullerthan the outer, in order to ensure asufficient covering for the internal con-dyle, which is longer and larger thanthe external. The outline of the flaps is shown in Fig. 418. (1) The skin-incisions on both the
A manual of operative surgery . he limb. It terminates as avertical cut opposite the centre of theinterarticular line. A second incision begins at the samepoint on the front of the limb as thefirst, and pursues a similar directionacross the inner side of the leg, meetingthe first incision at the median line uponthe posterior aspect of the inner flap should be a little fullerthan the outer, in order to ensure asufficient covering for the internal con-dyle, which is longer and larger thanthe external. The outline of the flaps is shown in Fig. 418. (1) The skin-incisions on both the right and the left leg aremore conveniently made by cutting from behind forwards. Theknife is entered at the posterior aspect of the limb, at a spotopposite to the centre of the interarticular line, and is drawnforwards, first upon one side of the limb and then upon the other,to reach the point of meeting one inch below the tubercle of thetibia. While the outer incision is being made the limb is rotatedinwards, and vice FIG. 418.—STEPHEN SMITH SDISARTICULATION AT THE KNEE. 636 AMPUTATIONS [part vi The knee-joint should be extended during the cutting ofthe flaps. (2) The skin is freed all round, and the two flaps are dissectedup. They should include all the soft parts down to the tendonsand muscles, which are well laid bare, but are as yet left patellar ligament is cut as soon as it is reached, being dividedagainst the tuberosity of the tibia. The flaps are retracted to the level of the joint-line. (3) An incision is now made along the extreme upper marginof the tibia. This incision, which is transverse and concernsthe anterior and lateral aspects of the bone, divides everything down to the bone, including the ilio-tibialband, the tendons of the sartorius, gracilis,semitendinosus, and biceps muscles, the inter-nal and external lateral ligaments, and, lastly,the coronary ligaments attaching the semi-lunar cartilages. The knife, indeed, entersthe joint between
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