A manual of operative surgery . itrarely causes discomfort. It is needless to say that the patient shouldbe supervised for at least a year after the operation, to prevent anyrecurrence of the deformity. In at least 10 per cent, of the casesPhelps was obliged to resort to some form of tarsectomy or modification of the open section (Kellock) is perhaps worthyof trial should the surgeon select this method ; a flap of skin andfascia is shaped from the dorsal tissues and moved over to the to fill the gap produced by Phelpss section. The flap (whichhas its pedicle towards the
A manual of operative surgery . itrarely causes discomfort. It is needless to say that the patient shouldbe supervised for at least a year after the operation, to prevent anyrecurrence of the deformity. In at least 10 per cent, of the casesPhelps was obliged to resort to some form of tarsectomy or modification of the open section (Kellock) is perhaps worthyof trial should the surgeon select this method ; a flap of skin andfascia is shaped from the dorsal tissues and moved over to the to fill the gap produced by Phelpss section. The flap (whichhas its pedicle towards the ankle) is then secured in place by sutures,and the other wound made is also sewn up in great part. Comments on the Operation.—It appears that many Americanorthopaedic surgeons, including, of course, Mr. Phelps, are still enthusi-astic in its favour. Some English authorities, such as Mr. EdmundOwen, endorse its value ; others condemn it strongly, and state thatno cases are so hopeless as those which have relapsed after Phelpss. FIG. 442.—SUCCESSFUL RESULT OF PHELPS S OPEN OPERA-TION FOk CLUB-FOOT. The vertical scar is thick, and lies in a deep furrow. chap, i] OSTEOTOMY FOR CLUB-FOOT 707 operation. Its drawbacks, as compared with the subcutaneousmethod, are obvious. There is a large wound to granulate up, and thescar resulting compares very unfavourably with the complete absenceof scar after subcutaneous operation. On the other hand, the foot isnot shortened, as after tarsectomy. Open section could never berequired in the early stage of club-foot, and should not be performedon infants. It may be useful in cases which have resisted subcutaneousdivision of tendons and ligaments, and in those in which tarsectomywould otherwise be required. Its advantages over the latter opera-tion are doubtful in inveterate cases, since in these the bones arealtered in shape, and this deformity will not be overcome by anydivision of soft parts alone. To suppose that an extreme case of club-foot
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