The surgeon's handbook on the treatment of wounded in war : a prize essay . SYMES disarticulation of the foot. 3. A transverse incision across the articular surface of the astra-galus opens the joint in front, and an incision below each malleolus di-vides the lateral ligaments; the upper articular surface of the astragalusis thus exposed. 2\l 4. While the left hand presses the foot more and more againstthe posterior aspect of the leg, and alternately twists it round its axisto one side or the other, the os calcis is liberated from its heel flap;the tendo Achillis is divided by incisions, which
The surgeon's handbook on the treatment of wounded in war : a prize essay . SYMES disarticulation of the foot. 3. A transverse incision across the articular surface of the astra-galus opens the joint in front, and an incision below each malleolus di-vides the lateral ligaments; the upper articular surface of the astragalusis thus exposed. 2\l 4. While the left hand presses the foot more and more againstthe posterior aspect of the leg, and alternately twists it round its axisto one side or the other, the os calcis is liberated from its heel flap;the tendo Achillis is divided by incisions, which follow closely uponone another, and are made alternately from above, from the side, andfinally from behind and below, but always cutting upon the bone (fig. 390). Fig. SYMES disarticulation (dissecting out the os calcis). Note. In secondary operations the calcaneus need not be dissected out withthe knife, hut can he conveniently shelled out from the periosteum with elevator andraspatory. 5. The heel flap is drawn upwards above the malleoli, whilsta circular incision, made just above the articular surface of thetibia, divides the remaining soft parts (tendons and periosteum). 6. The saw is applied to the bones, so as only to remove bothmalleoli and a thin layer of the articular cartilage of the tibia(fig. 391 and 392). The malleoli alone can be removed (as Syme has done severaltimes) with a pair of cutting bone forceps. Fig. 391.
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Keywords: ., book, bookcentury1800, booksubjectwoundsandinjuries, bookyear1884
