. Manual of operative surgery. s outside and in immediate juxtaposition to the still attached opposing surfaces of tendon should be vivified and sutured together. Phelps Operation.—Preliminary Treatment.—If the patient has walked,large callosities will be present on the foot; to soften and clean these soap poul-tices should be applied for twenty-four hours; twelve hours before the operationthe foot must be thoroughly scrubbed and an antiseptic fomentation applied. Step I.—Render limb avascular by elevation and apply tourniquet. Placethe foot, with outer side downwards, on a sand-bag.
. Manual of operative surgery. s outside and in immediate juxtaposition to the still attached opposing surfaces of tendon should be vivified and sutured together. Phelps Operation.—Preliminary Treatment.—If the patient has walked,large callosities will be present on the foot; to soften and clean these soap poul-tices should be applied for twenty-four hours; twelve hours before the operationthe foot must be thoroughly scrubbed and an antiseptic fomentation applied. Step I.—Render limb avascular by elevation and apply tourniquet. Placethe foot, with outer side downwards, on a sand-bag. Have the assistant holdthe heel firmly. Grasp the distal portion of the foot and make the plantartissues tense. Step 2.—On the inner side of the foot make an incision beginning directlyin front of the malleolus and ending one-fourth of the distance across the soleof the foot. Divide all resisting structures, penetrating to the bone if necessary.(See Fig. 1580; here the cut is being made from the sole to the malleolus.). Fig. 1580.—Phelps operation. Step 3.—By manipulation complete the overcorrection of the varus. Step 4.—Correct the equinus by a tenotomy of tendo Achillis. Step 5.—Pack the wound with sterile iodoform gauze. Dress. Immobilizein a position of overcorrection by a plaster-of-Paris bandage, which reacheswell up the calf. While the plaster is hardening, hold the foot in its new positionby means of a flat board laid against the sole. Step 6.—Remove the tourniquet. Elevate the limb for twenty-four cleanliness has been attained, the dressings may be left untouched for fromtwo or three weeks, when the wound will generally be found practically healed. Tarsectomy.^—Occasionally the above operation may be found insufficientto produce overcorrection. Having divided the soft parts as described, cutthrough the neck of the astragalus with a chisel. In packing the wound donot introduce the gauze into the cleft in the bone. After-treatment.^—^Plaste
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