. Operative surgery. prac-ticed when the integument at the seat of the deformity is too short to permitof rectification after a free subcutaneous division of the constricted tissues. The Operation.—After the employment of thorough antiseptic precau-tions and the application of the elastic bandage^, make an incision beginningdirectly in front of the inner malleolus and passing downward to the innerside of the neck of the astragalus. Through this incision divide respect-ively such of the following structures as offer resistance to the rectificationof the deformity: the tendon of the tibialis pos
. Operative surgery. prac-ticed when the integument at the seat of the deformity is too short to permitof rectification after a free subcutaneous division of the constricted tissues. The Operation.—After the employment of thorough antiseptic precau-tions and the application of the elastic bandage^, make an incision beginningdirectly in front of the inner malleolus and passing downward to the innerside of the neck of the astragalus. Through this incision divide respect-ively such of the following structures as offer resistance to the rectificationof the deformity: the tendon of the tibialis posticus muscle, the abductorpoUicis muscle, flexor brevis digitorum muscle, tendons of long flexormuscles, the elongations of the deltoid ligament and of the plantar fascia,and the calcaneo-scaphoid ligament, avoiding if possible the internal plantarnerve and artery. The wound should be dressed to secure organization ofblood clot (page 358) if possible, or treated in the usual manner of open OPERATIONS ON BONES. 4-49. Fig. 472.—Phelpss operation, four weeks after. wounds. At once or a few days later the raw surface may he covered withskin grafts. Fit dps advises that if the clastic constriction l)o employed thedressing he applied he-fore its removal, andthat the extremity heslung in a perpendicu-lar position for fromfour to six hours there-after. The deformitymust he corrected he-fore application of thedressing, and he im-movahly confined inthe rectified positionhy plaster of Paris orother acceptahle means. The Besulis. —Phelps reports onehundred and sixty-oneoperations, of whichten cases were foundto have relapsed one year after, due, it is claimed, to neglect. The cases healpromptly with hut few exceptions, and serviceahle limhs are secured(Fig. 472). The Enucleation of the Astragalus (Lund).—This procedure is practiced,and with much success, in inveterate cases of cluhfoot. As the method ofexcision has heen described already (page 410) nothing further need headded at t
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