A manual of operative surgery . FIG. 407.—A, Guyons supramalleolar am-putation : a, Saw-line for that opera-on; B, Duvals supramalleolar ampu-tation : b, Saw-line for that FIG. 408.—STUMP LEFT BY GUYONSSUPRAMALLEOLAR AMPUTATION. [After Farabeuf.) heel flap. This must include all the soft parts down to the exception may be made of the peronei tendons behind the externalmalleolus. They need not be disturbed, and should not be divideduntil a level above the ankle-joint has been reached. Great caremust be taken of the vessels on the inner side of the os calcis. Thetendo Achilli
A manual of operative surgery . FIG. 407.—A, Guyons supramalleolar am-putation : a, Saw-line for that opera-on; B, Duvals supramalleolar ampu-tation : b, Saw-line for that FIG. 408.—STUMP LEFT BY GUYONSSUPRAMALLEOLAR AMPUTATION. [After Farabeuf.) heel flap. This must include all the soft parts down to the exception may be made of the peronei tendons behind the externalmalleolus. They need not be disturbed, and should not be divideduntil a level above the ankle-joint has been reached. Great caremust be taken of the vessels on the inner side of the os calcis. Thetendo Achillis is cut, and the soft parts are cleared away from thebones of the leg up to a point about two inches above the tips of themalleoli. It is convenient to sit in order to dissect up the posterior flap. The foot should now be extended, and the anterior incision carriedwell down to the bone, care being taken to avoid opening the ankle-joint. The soft parts on the front of the leg are dissected up to thelevel named. Retractors having been adjusted, the bones are divided horizontallywell above the bases of the malleoli. 610 AMPUTATIONS [part vi The posterior tibial nerve should be
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