A manual of operative surgery . lect. Hemorrhage.—-The two dorsal digital arteries will be cut at thecorners of the dorsal incision. They are small, and usually do notneed to be secured. If the flap has been well cut, the two plantardigital arteries will not be wounded, but will lie buried in the flapuntil they anastomose at its free end. They may readily be cut ifin dissecting the flap back the knife is not kept close to the also lie near to the sides of the joint (plantar aspect), and maybe easily wounded in careless disarticulation. In amputation through the last phalanx of the gr
A manual of operative surgery . lect. Hemorrhage.—-The two dorsal digital arteries will be cut at thecorners of the dorsal incision. They are small, and usually do notneed to be secured. If the flap has been well cut, the two plantardigital arteries will not be wounded, but will lie buried in the flapuntil they anastomose at its free end. They may readily be cut ifin dissecting the flap back the knife is not kept close to the also lie near to the sides of the joint (plantar aspect), and maybe easily wounded in careless disarticulation. In amputation through the last phalanx of the great toe the sameoperation should be employed, the dorsal incision being made nearerthe nail. It should be a rule that no more of the great toe should * To avoid confusion of terms this note may be given : Flexion of a toe =the bending of the toe towards the sole—action of the flexor muscles. Flexionof the foot = the bending of the foot at the ankle so that the toes are broughtnearer to the shin—action of extensor chap, vi] AMPUTATION OF THE TOES >63 be removed than is absolutely necessary. An endeavour should bemade, when possible, to spare the base of the second phalanx. Byso doing the joint is undisturbed, and the insertions of the flexorand extensor tendons are saved. 2. Amputation or Disarticulation of the Distal Phalanges ofthe Four Outer Toes.—In operating upon the smaller toes the neigh-bouring digits should be held aside by the assistant by means of steril-ised tapes. It is well not to use too long a scalpel. The terminal phalanges may be removed by the operation justdescribed. In disarticulation of the second phalanx use the oval or racketincision. Grasp the toe with the left hand and flex it. Enter theknife i cm. above the joint and in themedian dorsal line. Continue the in-cision—which should be only skin-deep—along to the middle of thesecond phalanx. Now curve it downto the plantar margin, cutting to thebone. Forcibly extend the toe anddraw
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