A manual of operative surgery . he middle of thesecond phalanx. Now curve it downto the plantar margin, cutting to thebone. Forcibly extend the toe anddraw the knife transversely across itsplantar aspect. Still cut to the bone,and so make a good division of theflexor tendon. Cut up on the oppositeside of the toe to meet the straightdorsaEincision (Fig. 380, a). In thisstep cut also to the bone. Now let the assistant forcibly extendthe toe ; dissect up the lateral and plantar parts of the cut ; divide the glenoid ligament transverselyagainst the base of the second phalanx, and thus open the joi
A manual of operative surgery . he middle of thesecond phalanx. Now curve it downto the plantar margin, cutting to thebone. Forcibly extend the toe anddraw the knife transversely across itsplantar aspect. Still cut to the bone,and so make a good division of theflexor tendon. Cut up on the oppositeside of the toe to meet the straightdorsaEincision (Fig. 380, a). In thisstep cut also to the bone. Now let the assistant forcibly extendthe toe ; dissect up the lateral and plantar parts of the cut ; divide the glenoid ligament transverselyagainst the base of the second phalanx, and thus open the joint. Thendivide the lateral ligaments, and nothing will retain the toe but theextensor tendon. Pull upon the toe and divide this tendon as highup as convenient. Close the sheath of the flexor tendon (page 492).The cicatrix will be vertical, dorso-plantar. Hcemorrhage.—Two dorsal and two plantar digital arteries arefound cut in the lateral edges of the wound. The dorsal will requireno attention ; the latter may be >.—A, Disarticulation of thesecond phalanx of a toe by theracket or oval incision; B, Dis-articulation of the great toe bythe racket or oval incision. II. DISARTICULATION AT THE METATARSO-PHALANGEAL JOINTS, ETC. 1. Disarticulation of the Great Toe at the Metatarso-phalangeal Joint.—In this operation notice must be taken of the very 564 AMPUTATIONS fPART VI large size of the head of the metatarsal bone. Its dimensions areincreased by the presence of the sesamoid bones, which should neverbe removed with the phalanx. It is of considerable importance tothe future use of the foot that the head of the metatarsal bone shouldbe preserved, and it will be seen that the chief difficulty of the opera-tion is to provide flap enough to cover the projection. It is importantalso that the scar should be away from the plantar surface and theline of the sesamoid bones. The joint can be readily made out by manipulation, especially onthe inner aspect of the foot. It
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