A system of surgery . ods, at the optionof the surgeon. In exceptional circumstances the amputation mightbe successfully accomplished just below the knee, through the 920 DISEASES OF BONES. tibia, but great care must be taken that the soft parts are reallyfree from infiltration. If the disease be situated in the upper thirdof tibia, the amputation must be done through the lower third ormiddle of thigh, according to the extent of growth. An endostealsarcoma of tibia may be removed by amputation, just above thedisease. A re-section would leave a useless limb. Fibula.—A periosteal sarcoma should
A system of surgery . ods, at the optionof the surgeon. In exceptional circumstances the amputation mightbe successfully accomplished just below the knee, through the 920 DISEASES OF BONES. tibia, but great care must be taken that the soft parts are reallyfree from infiltration. If the disease be situated in the upper thirdof tibia, the amputation must be done through the lower third ormiddle of thigh, according to the extent of growth. An endostealsarcoma of tibia may be removed by amputation, just above thedisease. A re-section would leave a useless limb. Fibula.—A periosteal sarcoma should be removed by amputationon the same lines as for the tibia. An endosteal sarcoma of the fibula may fairly be submitted tore-section, and the case carefully watched. Femur.—In the lower third of the femur a subperiosteal sarcomawould require amputation as high up towards the hip-joint as safetyto the patient from shock would dictate. Skin-flaps and sawingthrough the neck of femur or trochanters would probably be as. Fig. 359.—Parosteal spindle-celled Sarcoma between the first and second metatarsal the case shown in Fig. 35S. Removed by Lisfrancs amputation, 1890. No recur-rence four years afterwards. (St. Thomass Hospital Museum, No. 2589.) serviceable, so far as local recurrence is concerned, as disarticulationat the hip-joint. See Fig. 357, where success was obtained by amuch lower amputation. In the middle of the thigh nothing less than amputation at thehip-joint, with short skin-flaps, would be of any avail. And eventhis can only be successful quite early in the disease, or where itappears not to have spread rapidly along the shaft. A subperiostealsarcoma in the upper end of the femur must be regarded as hopelessfrom an operators point of view. An endosteal sarcoma of the femur would require amputationimmediately above the disease. In the head and neck of femur—where, however, it is exceptionally rare—re-section might be thoughtof on account of the dange
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