. Manual of operative surgery. he fibula, the baseof the wedge being directed towards the tibia (Fig. 1462, X). Step 4.—Bend or break the fibula so that it may be laid over the sawn sur-face of the tibia. Vivify the surface of the fibulaapposed to the tibia. Attend to the wound with deep and superficialsutures in such a manner that the mobilizedportion of fibula is left in contact with the endof the tibia. Excellent results have been ob-tained by this operation which seems simpleand sensible. Authors Amputation.—In performing Biersosteoplastic amputation the author has beenstr
. Manual of operative surgery. he fibula, the baseof the wedge being directed towards the tibia (Fig. 1462, X). Step 4.—Bend or break the fibula so that it may be laid over the sawn sur-face of the tibia. Vivify the surface of the fibulaapposed to the tibia. Attend to the wound with deep and superficialsutures in such a manner that the mobilizedportion of fibula is left in contact with the endof the tibia. Excellent results have been ob-tained by this operation which seems simpleand sensible. Authors Amputation.—In performing Biersosteoplastic amputation the author has beenstruck by its diflaculty and by the ease withwhich the plate of bone falls off the periostealflap at the last moment. Little or no nourish-ment can reach the bone fragment through theperiosteum which really acts merely as a hinge;he therefore operates as follows: 1. Reflect the soft parts by the circular orflap method but leave the periosteum intact. 2. Transversely divide the periosteum of the tibia along two lines separated. Fig. 1463. ii8o AMPUTATION OR DISARTICULATION from each other by a space about 3^^ inch greater than the diameter of thebone (Fig. 1463). From the upper incision separate the periosteum downwards for about 3<4inch. From the lower incision separate the periosteum upwards for about ^inch. With a saw cut through the compact bone transversely near the baseof the periosteal flaps. With an osteotome cut free the plate of bone betweenthe two saw cuts. This plate of bone is covered by periosteum which hangsover its upper and lower edges like a table cloth. Preserve the plate ofbone in warm salt solution or in gauze moistened with salt solution. 3. Choose the line of bone section and after forming periosteal cufT dividethe bone. Attend to hemostasis. 4. Place the plate of bone over the cut surface of the tibial stump (rawsurface to raw surface) and suture the periosteum of the plate to the periosteumof the tibia. 5. Close the wound secundum artem. In amputatio
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