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Show 280 AMPUTATION NEAR THE ANGLE. .‘iMPUTATION OF THE TOES AND FINGERS. out being withdrawn) is to be carried in a circular direc tion, B, over the tibia and fascia, which covers the tibialis anticus, until it meets the angle of the first incision, on the outside of the limb. 2. The assistant continuing to pull the integuments up, the surgeon takes a sharp-pointed scalpel, and pierces the interosseous membrane, and separates the periosteum from the bone. , 3. The sawing of the bone being made with the same pre caution as in the last instance, and the arteries being sccurw ed, the flap is brought up upon the face of the bone, and the point A, meets the integuments B. Thus, if adhesion be procured, or if the flap connects itself after suppuration, a cushion is afl‘orded to the ends of the bones, and the patient may probably be able to bear his weight upon a false leg and foot, by which he has the use of the joint of the knee. The method I have here described, I prefer to that man- ..|__ i.___,, "g. ".1 . ner of operating in which the catiline is thrust down behind the bones, and then made to cut its way out obliquely downward, so as to form the flap. The vessels to be taken up are still the same, nearly, as has been already mentioned. The posterior tibial artery and the fibular are very near each other. The tibialis posti« ea in the interstice betwixt the tibialis posticus muscle and the flexor digitorum. We have to guard against hooking out. the nerve along with it. The fibular artery lies near the fibula, and betwixt it and the flexor pollicis magnus. The tibialis antica is before the ligament, under the exten~ sor conimunis, and betwixt the tibia and fibula. In the dressing of the stump, the same precautions are u:~ ed to bring up the flap over the face of the stump, and to support it by straps, by an elastic cushion of but and tow; and yet to be careful that the flap does not press too math or unequally on the ends of the bones, OF THE AMPUTATION OF THE TOES AND FINGERS. THE amputation of the metatarsal bone of the great toc ‘may be necessary, or that of the metatarsal bone of the little toe ; but I conceive, from what I have seen of the pain and difficulty of extracting any of the intermediate metacarpal. bones, and considering the effects of such a torturing and tedious wound among the bones and ligaments of the foot, that. it should not be performed. But instead of a formal operation, under the head of amputation, I have no doubt that the careful and nice extrac- tion of the spoiled bones from the hand or foot, in caries, should be oftener done than it is. In the amputation, where the surgeon endeavours to disla cate the square head of the metacarpal bone, the patient is kept long in extreme torture, and the diseased bone is gene~ rally broken in the surgeon's fingers. On one occasion, a patient (though certainly in a very unfavourable state of health) died in consequence of the opt-ration, from the immediate nervous irritation. Instead of dislocating the head of the bone, it is better to cut it with the trophine. I have adapted the instrument, fig. 2, for this purpose. It cuts only on one half its circle. When the metatarsal bone of the great or little tee is to be taken out, the inrision is to be made thus. 1. First we may the scalpel round the root of the tee {a}, and then down the side of tha" foot (b1 it won M09917] |