Modern surgery, general and operative . the lineof the artery and over the annular ligament. This incision is external tothe tibialis anticus muscle and h inch from the outer border of the tibia(Barker). Divide the skin and fascia, retract the tendon of the tibialis anticusinward, and the tendon of the extensor proprius pollicis outward, along withthe tendons of the extensor communis. Flex the ankle-joint to relax thetendons and clear the arter\^ Draw the nerve external and pass the ligaturefrom without inward. In order to recognize the muscles in this as in otherligations, rely largely upon t
Modern surgery, general and operative . the lineof the artery and over the annular ligament. This incision is external tothe tibialis anticus muscle and h inch from the outer border of the tibia(Barker). Divide the skin and fascia, retract the tendon of the tibialis anticusinward, and the tendon of the extensor proprius pollicis outward, along withthe tendons of the extensor communis. Flex the ankle-joint to relax thetendons and clear the arter\^ Draw the nerve external and pass the ligaturefrom without inward. In order to recognize the muscles in this as in otherligations, rely largely upon the finger while the muscles are being moved. Ligation of the Middle Third.—In this operation the procedure is similarto the above. Remember that the nerve lies in front of the vessel and thatthe extensor proprius pollicis muscle is external. The nerve is retractedoutward and the needle is passed from the nerve. A good rule for detectingthe artery is to find the outer edge of the tibia and by this locate the inter- LIGATIONS. Plate < < Posterior Tibial Artery 485 osseous membrane, and then, by passing out along this membrane, discoverthe artery. Ligation of the Upper Third.—Make an incision 3 inches long in the arte-rial line. On opening the deep fascia, do not rely on the eye for finding themuscular interspace, as often the latter cannot be seen, and neither a whitenor a yellow line is reliable. Place the index-finger deep in the wound and havethe tibialis anticus and extensor communis digitorum muscles successivelyrendered tense by an assistant. In opening the interspace use the handleof the knife. Relax the muscles, retract the tibialis anticus inward and drawthe extensor communis digitorum outward. Find the interosseous membranewhere it is attached to the edge of the tibia, and the artery will be found uponthis membrane, between the tibia and the nerve. Clear the vessel and passthe ligature from without inward to avoid the nerve. Posterior Tibial Artery.—The
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
