. Operative surgery. IONS ON BONES. 415 of the recoveries from this operation results in a more or less serviceablelimb ; about nine per cent are useless. Osteoplastic Resection of the Tarsus (Wladimirow-Mikulicz).—Thisoperation is sometimes practiced instead of amputation for relief from exten-sive disease and injury of the tarsal bones and for paralytic talipes. The Operation.—Beginning about half an inch behind the tuberosityof the fifth metatarsal bone, make a transverse incision down to the boneacross the sole of the foot to a point immediately in front of the tuberosityof the scaphoid. M
. Operative surgery. IONS ON BONES. 415 of the recoveries from this operation results in a more or less serviceablelimb ; about nine per cent are useless. Osteoplastic Resection of the Tarsus (Wladimirow-Mikulicz).—Thisoperation is sometimes practiced instead of amputation for relief from exten-sive disease and injury of the tarsal bones and for paralytic talipes. The Operation.—Beginning about half an inch behind the tuberosityof the fifth metatarsal bone, make a transverse incision down to the boneacross the sole of the foot to a point immediately in front of the tuberosityof the scaphoid. Make an incision down to the bone at either side ofthe foot from each end of the transverse one upward and backward tothe posterior borders of the respective malleoli. Unite the upper ends ofthese incisions by a posterior transverse one and divide the tendo Achillis;flex the foot sharply; open the ankle joint from behind; sever the lateral ligaments; enucleate and remove theastragalus and os calcis; saw thin disks. Fig. 431.—^Wladimirow-Mikuliczs osteo-plastic resection of the tarsus, a. In-cision through the soft parts, b. Di-vision of the bone. c. Position of thefoot after the operation. Fig. 433.—Result after osteoplastic re-section. of bone from the exposed extremities of the tibia and fibula, and from theexposed surfaces of the scaphoid and cuboid bones; divide subcutaneouslythe flexor tendons of the toes so that the latter may be extended to a rightangle with the dorsum of the foot; bring in contact and fasten together thesawed bony surfaces with sutures, and close the wound of the soft parts (Fig,431, c). The extremity is then dressed and confined by means of a plaster-of-Paris splint until healing is completed, after which it is fitted with a suit-ably constructed shoe (Fig. 432). The Comments.—Berger, in order to preserve the integrity of the pos-terior tibial artery and nerve, approached the ankle joint through a T-shapedincision made at the outer side. The p
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