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Show 275 AMPUTA'IION BELOW' THE KNLE. AUPUTKTIOW NEAR THE ANFLF. 3. In the sawing of the bones of the leg, there is somewhat more caution necessary than in the sawing of the thigh bone. The meaning of the surgeon standing on the inside of the leg" is that he may rest the stress of his saw on the firmer an; and while he is making progress in cutting through the tibia, the fibula is at the same time cut through. Unless this be done, the latter is very apt to be splintered. 1i. In the face of the stump there is a better mark by CHAPTER VIII" AMPUTATION NEARER THE ANCLE. which to find the mouths of the arteries, than in that of the thigh. The anterior tibial artery, lying before the interosseous membrane, and betwixt the extremities of the bones. The fibular artery, lying behind the fibula. The posterior tibial artery, lying to the inside of the last, and among the fibres of the soleus, near the tibia. »- , warm" , ,. ~2 jinn" "Mam", "It" ., These mug" all be 59011‘50‘1- The lesser branches, which require the ligature, are-that small artery behind the tibia ‘V 1111:; the disease is in the foot, it is better to am» putate lower in the leg, where the bone is smaller; yet not so low but that there may be sufficient muscular substance of the soleus and flexe' muscles, to cover the face of the bones. Whether we perform the flap operation, as it is called, or not, still here we must contrive so to manage the knife that. which gives off the nutritious artery, and the nuiscular there may be a sufficient length 0f muscular substance (and branches on the outside of the gastroenemii, and in the sub. of integuments to cover that muscular substance) to admit stance of the gastrocnemii and soleus. of the back part of the [lap being brought forward over the 5‘ The dreSSmS in this Operation is much the same as in the last operation. But unfortunately the great size of the tibia, and the thir- face of the bones. The rear OPERATION may be thus performed :- ness of the integuments over the fore-part of it, makes it some- what of a more precarious operation than the amputation above the knee. \Ve must be particularly careful in apply- ing the adhesive straps and bandages, that the skin be not pressed against the sharp edge on the fore-part of the tibia. The neglect of this precaution, with the great size and superficial situation of the bone in the stump, is frequently the cause of a tenderness and suppuration in the skin, and too often that of a caries of the bone. 1. \Vith the large amputating knife, we make an oblique leg. cut upwards, through the skin of the back part of the again knife The assistant drawing up the skin, we enter the e at the upper margin of the cut A, and carry it obliqu 1y upward until it reaches the bones. The knife then (With- ' WON] M099 __| 7 ‘ if! |
