A manual of operative surgery . e foot is disarticulated, and the soft parts arethen dissected away from the inner side of the os calcis in somewhatthe same manner as is described in the section on Farabeufs sub-astragaloid amputation. The malleoli are removed as in Symes procedure is difficult and tedious, and is, on the whole, inferiorto Symes operation. The flap, if well cut, is certainly better nourished,but a greater demand is made upon the integuments of the foot. Farabeufs Operation.—In all essential points this operation isidentical with the subastragaloid amputation of
A manual of operative surgery . e foot is disarticulated, and the soft parts arethen dissected away from the inner side of the os calcis in somewhatthe same manner as is described in the section on Farabeufs sub-astragaloid amputation. The malleoli are removed as in Symes procedure is difficult and tedious, and is, on the whole, inferiorto Symes operation. The flap, if well cut, is certainly better nourished,but a greater demand is made upon the integuments of the foot. Farabeufs Operation.—In all essential points this operation isidentical with the subastragaloid amputation of the same surgeon(page 584). The incision is commenced on the outer side at the insertion ofthe tendo Achillis. It is carried horizontally forward (touching thetip of the external malleolus) to a point just in front of the calcaneo-cuboid joint (corresponding to b, Fig. 393). It then crosses thedorsum to reach the extensor proprius pollicis tendon, just in frontof the astragalo-scaphoid joint (corresponding to x, Fig. 393). It. FIG. 401.—ROUXS AMPUTATION. AMPUTATIONS OF THE FOOT 597 now sweeps over the inner border of the foot, crossing the scapho-cuneiform joint (corresponding to x to c, Fig. 393, and b, Fig. 402),and is then carried back along the median line of the sole (corre-sponding to d to E, Fig. 393, and f, Fig. 399), to end at the insertionof the ten do Achillis. The flaps are dissected back as far as con-venient, the ankle-joint is opened from the outer aspect of the foot,and the disarticulation and the clearing of the os calcis are effectedprecisely in the manner already described. A good thick vascular flap is provided, but the operation is lesseasy to execute than Symes, and has no distinct advantage overthat admirable procedure. 2. INTRACALCANEAL AMPUTATIONS OF THE FOOT (1) Pirogroff s Operation.—This operation closely resemblesSymes, save that the os calcis is sawn through and its hinderpart is left in the heel flap. The lower ends of the tibia andfibula ar
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