File:Text-book of operative surgery (1903) (14784342033).jpg

Identifier: textbookofoperat1903koch (find matches)
Title: Text-book of operative surgery
Year: 1903 (1900s)
Authors: Kocher, Theodor, 1841-1917 Stiles, Harold J
Subjects: Surgery, Operative Surgery
Publisher: London : Adam and Charles Black
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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l knife, and, lastly, the plantar tendonsare cut across as high up as possible. 299. Amputation through the Metatarsus (Fig. 215). This operation has the LOWER EXTREMITY 395 advantage over the tarso-metatarsal disarticulation that the insertions of the chiefmuscles of the foot are all retained, not merely the tibialis posticus and peroneuslongus, but also the tibialis anticus and the peroneus brevis and tertius. Hence thefoot retains its normal movements in all directions. It is also very serviceable as asupport, as the important projection at the base of the fifth metatarsal is left, and theonly one which is wanting is that of the head of the first metatarsal. An oblique incision is carried, with a single sweep of the knife, through the musclesdown to the bone so as to avoid the branches of the internal and external plantararteries. A small knife is then carried round each of the metatarsal bones : theperiosteum is divided and retracted and the bones sawn across. The oblique circular
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Fig. 213. — Disarticulation ofthe great toe at the meta-tarso- phalangeal joint, andof the 2nd toe along withits metacarpal bone : am-putation through the 3rd toe,and through the 5th meta-tarsal bone. Fig. 214.—Disarticulation of all the toes at the metatarso- Fig. 215.—Amputation phalangeal joints. through the metatarsus. incision is better than the transverse circular, as the scar in the former case is on thedorsum. 300. Disarticulation at the Tarso-Metatarsal Joints—between the metatarsusanteriorly and the three cuneiforms and cuboid posteriorly (Lisfrancs operation)(Figs. 216 and 217). The line of the joint lies immediately behind the tuberosity of the fifth metatarsalon the outer side of the foot. The guide on the inner side is the slight prominence ofthe base of the first metatarsal. With a finger of the left hand on each of these fixedpoints, an incision is carried along each side of the foot, and then across the sole at thelevel of the ball of the toes, thus forming a

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