A manual of operative surgery . evel basisof support. An excellent flap is provided. The dorsal incision has its concavity up-wards and inwards. It commences at theouter edge of the tendo Achillis, on a levelwith the tip of the external malleolus. Itsweeps forwards about one inch below thatpoint of bone, passes a fingers-breadth behindthe tuberosity of the metatarsal bone, andends at the inner side of the extensor proprius pollicis tendon, twofingers-breadth in front of the ankle-joint. The plantar incisioncommences at this point, is carried over the inner cuneiform boneat the internal margin
A manual of operative surgery . evel basisof support. An excellent flap is provided. The dorsal incision has its concavity up-wards and inwards. It commences at theouter edge of the tendo Achillis, on a levelwith the tip of the external malleolus. Itsweeps forwards about one inch below thatpoint of bone, passes a fingers-breadth behindthe tuberosity of the metatarsal bone, andends at the inner side of the extensor proprius pollicis tendon, twofingers-breadth in front of the ankle-joint. The plantar incisioncommences at this point, is carried over the inner cuneiform boneat the internal margin of the foot, sweeps with a curve across thesole, reaches the outer edge of the foot about the base of the fifthmetatarsal, and then joins the dorsal incision (Fig. 404). The incision extends to the bone. The flaps are dissected backso as to make clear the medio-tarsal joint. Disarticulation is noweffected as in Choparts operation. With a rugine the whole of theunder part of the os calcis is bared of periosteum, the plantar flap. FIG. 404.—TRIPIER SOPERATION. chap, viii] AMPUTATIONS OF THE FOOT 601 having been dissected up as high as the sustentaculum tali. The oscalcis is now seized with lion forceps and so turned as to expose itsinner surface well. The saw-cut is made horizontally, just below thesustentaculum, and runs from the inner to the outer surface (, d). The angle which the cut surface of the os calcis forms withthe cuboid surface of that bone is finally rounded off with the saw,and the operation is complete. AFTER-TREATMENT OF AMPUTATIONS OF THE FOOT Many of the observations already made with reference tothe after-treatment of amputations of the toes and of portionsof the foot apply to the present procedures. The stump should be protected from pressure of the bed-clothes The limb should be a little raised upon a firm pillow. A back-splint should be adjusted precisely as advised in thecase of some of the previous operations (page 484 and Fig. 357). Care must be
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