. Minor and operative surgery, including bandaging . ance, as that advocated by Han-cock, who has combined Pirogoff s amputation with thesubastragaloid method, bringing the sawed surface of theos calcis in contact with a transverse section of the astrag-alus. Hancock has advocated the propriety of amputatingthe foot without regard to the posi-tion of the tarsal joints, cutting theflaps of sufficient length and divid-ing the bones with a saw. Trlpier has also modified the sub-astragaloid amputation by leavingthe upper part of the calcaneum,which he saws through on a levelwith the sustentaculum
. Minor and operative surgery, including bandaging . ance, as that advocated by Han-cock, who has combined Pirogoff s amputation with thesubastragaloid method, bringing the sawed surface of theos calcis in contact with a transverse section of the astrag-alus. Hancock has advocated the propriety of amputatingthe foot without regard to the posi-tion of the tarsal joints, cutting theflaps of sufficient length and divid-ing the bones with a saw. Trlpier has also modified the sub-astragaloid amputation by leavingthe upper part of the calcaneum,which he saws through on a levelwith the sustentaculum tali, and atright angles to the axis of the leg;the external incisions are made asin Choparts amputation. In the method advocated by Miku-licz the astragalus and calcaneum areremoved, the ends of the tibia andfibula are sawed off, and the sawedsurfaces of the scaphoid and cuboid are approximated to these, the Stump Union between calcaneum^.r , ?,. ,i o , n and tibia in Pirogoffs am- resulting resembling the toot ot pes putation. (Hewson.) AMPUTATIONS OF THE LEG. The leg may be amputated at its lower, middle, or upperthird, the rule being to save as much of the limb as pos-sible ; but as regards the application of prosthetic^ appa-ratus, I think the stumps resulting from amputations inthe middle and upper thirds will be found more satisfac-tory. It is well also in sawing the bones to divide the 522 AMPUTATIONS. fibula at a slightly higher point than the tibia. Thecircular, modified circular, oval, elliptical, long anteriorflap, rectangular flap, antero-posterior flap, lateral flap, orexternal flap method may be employed. Circular Method.—A circular incision is made throughthe skin and connective tissue just above the malleoli, thecuff is dissected up for a sufficient distance, a circularincision of the tendons and muscles is next made, and thetissues being retracted, the bones are divided with a saw. Modified Circular Method.—In this method of anipu- Fig. 426.
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