. Manual of operative surgery. eps of the samepattern. Each tendon is carefully sutured and a fine stitch is placed in thefascia to cover the line of suture in the tendon., Then the skin is sutured overall. If drainage seems necessary, this is applied through and through, and evenin cases apparently requiring no drainage, I have usually passed a few strandsof catgut or silkworm-gut entirely across the foot, permitting the ends to pro-trude from the lower angles of the wound in order to drain the serum which maybe secreted by the large surface during the first few days. A large dressing isappli
. Manual of operative surgery. eps of the samepattern. Each tendon is carefully sutured and a fine stitch is placed in thefascia to cover the line of suture in the tendon., Then the skin is sutured overall. If drainage seems necessary, this is applied through and through, and evenin cases apparently requiring no drainage, I have usually passed a few strandsof catgut or silkworm-gut entirely across the foot, permitting the ends to pro-trude from the lower angles of the wound in order to drain the serum which maybe secreted by the large surface during the first few days. A large dressing isapplied and the foot is immobilized in a position at a little less than right angle. After-treatment.—The foot is elevated in order to favor return drainage has been employed, this is left in place from one to two dressing is not changed, unless this is indicated by the discharge, for a io66 ANKLE week or ten days, in order to avoid moving the foot, and after that as seldomas possible for the same Fig. 1324.—Excision of ankle. (Oclisncr.) —The prognosis is very good after this operation. The freeexposure of the surfaces insures thoroughness, and consequently the cure isusually permanent. The anchylosis of the surfaces immediately in the fieldof operation does not interfere with movement because the tarso-metatarsaljoint will supply the motion necessary. The tendons unite readily and act DISLOCATION ASTRAGALUS I067 normally. There is no operation for the relief of joint tuberculosis that hasgiven me more satisfaction than this one just described. With this methodit is possible often to obtain a useful foot in cases which formerly could only berelieved by an amputation (Ochsner, Clinical Surgery, p. 727). Remarks.—Arthrotomy is indicated in cases of pyogenic arthritis to providedrainage. It may also be used as a preliminary to filling the joint cavity withiodoform emulsion. Arthrectomy is rarely indicated. The results are notusually
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