. Manual of operative surgery. Fig. 1546.—Tendon transplantation. {Berger aftd Banzet.) , Peroneus longus. Tendon AchiUis. Peroneus brevis. i. Intact portion tendon peroneuslongus. 2. Flap from peroneus longus. 3. Flap from tendo AchiUis. Step 4.—Split the tendon into an outer and inner segment. Leave theouter segment intact. Divide the inner segment transversely, low downbelow the malleolus, so as to form a flap with its pedicleabove. Step 5.—Put the foot in a position of equinus andhold it there. Lay the two flaps of tendon (from theperoneus longus and from the tendo AchiUis)
. Manual of operative surgery. Fig. 1546.—Tendon transplantation. {Berger aftd Banzet.) , Peroneus longus. Tendon AchiUis. Peroneus brevis. i. Intact portion tendon peroneuslongus. 2. Flap from peroneus longus. 3. Flap from tendo AchiUis. Step 4.—Split the tendon into an outer and inner segment. Leave theouter segment intact. Divide the inner segment transversely, low downbelow the malleolus, so as to form a flap with its pedicleabove. Step 5.—Put the foot in a position of equinus andhold it there. Lay the two flaps of tendon (from theperoneus longus and from the tendo AchiUis) alongsideeach other and unite them with sutures. Step 6.—Shorten the intact portion of the tendoAchfllis. Step 7.—Close the wound. Dress. Immobflize ina position of equinus. (D) A combination of operations B and C may beemployed. (E) Transference of slips from the tibialis posticusand peroneus longus to the paralyzed tendo AchiUis. Step I.—Make the forked incision A B C D ( 1547). Reflect the flaps A B C, A B D, C B D. In Fig. 1547.—Tendontransplantation.(Labey.) doing this preserve and retract the external saphenous vein and nerve which lie at the outer side of the tendo AchiUis. Step 2.—SpUt the fascia so as to expose the outer edge of the tendoAchiUis. Freely split open the sheath of the peronei. I2I4 TENDON SHEATHS AND TENORRHAPHY Step 3.—Divide the tendon of the peroneus longus into an anterior andposterior segment. The muscle fibres are inserted into the tendon in thepennate fashion, therefore it is easy to continue the cut in the tendon up-wards so as to form two muscular bellies each attached to a slip consisting ofhalf of the tendon (Fig. 1548). Carefully avoid injury to any nerves enteringthe muscle. Transversely divide the posterior slip of tendon as low downas possible. Step 4.—Make a longitudinal cut into the outer side of the tendo the edges of the cut so as to form a gutter (Fig. 1548). Implant themobilized posteri
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