A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . osity of the fifth meta-tarsal bone to a point just behind the tuberosity of the scaphoid; andthen a plantar flap is made similar to that in the tarso-metatarsal op-eration, but not so long. It may be well in both of these operations to-divide the tendon of Achilles to preclude retraction of the heel. In the tibio-tarsal disarticulation the foot is placed at a right anglewith the leg and a cut down to the bone is made from the t
A manual of modern surgery : an exposition of the accepted doctrines and approved operative procedures of the present time, for the use of students and practitioners . osity of the fifth meta-tarsal bone to a point just behind the tuberosity of the scaphoid; andthen a plantar flap is made similar to that in the tarso-metatarsal op-eration, but not so long. It may be well in both of these operations to-divide the tendon of Achilles to preclude retraction of the heel. In the tibio-tarsal disarticulation the foot is placed at a right anglewith the leg and a cut down to the bone is made from the tip of onemalleolus, around the sole of the foot to the tip of the othermalleolus. The foot is then extended on the leg and a transverse cutmade across its dorsum from one end of the first incision to the second incision is convex forwards. The ankle joint is thenopened, the astragalus detached from the tibia, the calcaneum removedfrom the heel, and the malleoli and part of the lower end of the tibiasawed off. The cup-like heel flap is then turned up over the end ofthe tibia. Care must be observed not to injure the posterior tibial Fig. 472. Fig. Mikulicz-Wladimirovrs osteoplastic resection ofthe tarsus : 1, incision through the soft parts (a 6)and division of the bone ; 2, position of the footafter the operation. iTillmanns.) Final result after osteoplastic resection of the-tarsus. (Tillmanns.) vessels at the inner side of the ankle, or the heel flap may slough. Inthe osteoplastic operation of Pirogoff and its modifications the incis-ions are similar to those in disarticulation at the ankle; but the plantarincision is carried obliquely farther forwards, and the calcaneum afterbeing sawed obliquely upwards and backwards is turned up againstthe sawn end of the tibia. This method makes a longer stump thanthe tibio-tarsal disarticulation and may therefore be less suitable forthe adaptation of an artificial foot, but it enables the patient to walkwell with little li
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