The practice of surgery : embracing minor surgery and the application of dressings, etc., etc., etc. . s, while the inner flap isbeing safely completed. The arteries are tied and the wounddressed as in other cases. AMPUTATIONS OF THE LOWER EXTREMITY. Amputation of the Toes.—Amputation of the toes, and meta-tarsal bones are performed in the same manner as those of thefingers, and metacarpal bones. There is but one point of difference,that is, the necessity of saving the phalangeal extremities of themetatarsal bones; for the reason that the separation of the toes isno disadvantage, whilst the ab
The practice of surgery : embracing minor surgery and the application of dressings, etc., etc., etc. . s, while the inner flap isbeing safely completed. The arteries are tied and the wounddressed as in other cases. AMPUTATIONS OF THE LOWER EXTREMITY. Amputation of the Toes.—Amputation of the toes, and meta-tarsal bones are performed in the same manner as those of thefingers, and metacarpal bones. There is but one point of difference,that is, the necessity of saving the phalangeal extremities of themetatarsal bones; for the reason that the separation of the toes isno disadvantage, whilst the abutment furnished by the end of themetatarsal bone is of great importance. Amputation at the Metatarso-Tarsal Articulations.—Makean incision across the dorsum of the foot, from the tarsal end ofthe metatarsal bone of the great toe to that supporting the little AT THE METATARSO-TARSAL ARTICULATION. 155 one, or the proceeding may be reversed ; disarticulation havingbeen effected, the knife is placed behind the head of the bones,and a flap of sufficient length is procured from the sole of The formation of this flap in the first instance renders the dis-articulation more easy, and simplifies the whole operative pro-ceeding. A large bistoury is preferable to the catling, or smallamputating-knife generally used. A rounded flap is made by cuttingfrom the tibial to the fibular side, and vice versa, close to the rootsof the toes; it is turned back, and the two points, the commence-ment and termination of the first cut, are united by another in-cision carried across the dorsum in a semicircular form, and some-what beyond the articulations to be opened; the integument ispulled back, the cellular connexions being cut so as to permit fullretraction; the disarticulation is then completed with facility, thebones being forcibly bent towards the plantar aspect, more especi-ally during division of the ligaments which bind the head of thesecond metatarsal bone. The vessels are tied,
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