. Operative surgery. eg, and whose length equals its diameter. Dissect upwardthe flap thus formed; incise transversely at the apex of the flap, the peri-osteum on the subcutaneous surface of the tibia, and also longitudinallyupward from this part along the borders of the tibia to a sufficient lengthto form the flap (Fig. 628). The flap should be shorter for the tibia thanfor both bones; remove from the anterior surface of the tibia by means ofa Gigli-Haertel saw a bone flap, leaving attached the superimposed peri-osteum; fracture the bone flap at the base and turn it upward, the peri-osteum fo
. Operative surgery. eg, and whose length equals its diameter. Dissect upwardthe flap thus formed; incise transversely at the apex of the flap, the peri-osteum on the subcutaneous surface of the tibia, and also longitudinallyupward from this part along the borders of the tibia to a sufficient lengthto form the flap (Fig. 628). The flap should be shorter for the tibia thanfor both bones; remove from the anterior surface of the tibia by means ofa Gigli-Haertel saw a bone flap, leaving attached the superimposed peri-osteum; fracture the bone flap at the base and turn it upward, the peri-osteum forming a hinge (Fig. 629); unite posteriorly by a semicircular in-cision the upper ends of the primary flap; amputate the limb in the usualmanner, finally bringing down and applying to the end of one or bothbones, as the case may be, the periosteal flap (Fig. 630), which is thenfastened to the divided end or ends by chromicized catgut; bring downinto place the upper flap and close the wound in the usual manner, dress-. Pie. 627.—a. Grittis amputationb. Stokess incisions. AMPUTATION AT TIIR LOWER EXTRE:\IITY. 531 ing the stump quite firmly to hasten union of the complex flap, with over-lying simple tlap. Bier, in order to increase the supporting power at thelower end of the leg, removed a wedge-shaped piece (Fig. 631) from just
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