5 6 



APPLIED ANATOMY. 



be divided and the integrity of the flap threatened. In clearing the calcaneum it is 

 rather an advantage, especially in young people, to take off a thin slice of bone with 

 the tendo calcaneus. In removing the slice from the tibia as little as possible (in 

 growing patients) should be removed, to avoid injuring the epiphyseal cartilage. 

 In dissecting back the flap of the heel, the point of the knife is to be kept close to 

 the bone to avoid cutting the vessels in the flap itself. 



Pirogoff's Amputation. The sole incision is carried across from just in front 

 of the external malleolus to just in front of the internal. The anterior incision is 

 made across the front of the joint and the foot disarticulated by dividing the cap- 

 sular and lateral ligaments. The foot is then bent down and the calcaneum sawn 



Extensor longus digitorum 



Fibula 



Pcroneus longus 



Peroneus brevis 



Sawn surface of os calcis 



Extensor longus hallucis 

 Tibialis anterior 



Tibia 



Tibialis posterior 

 Flexor longus digitorum 

 Flexor longus hallucis 



Plantar vessels and nerves 



FIG. 576. Pirogoff's amputation of the ankle. 



through the tine of the sole incision. A slice is to be removed from the tibia and 

 fibula and the sawn surface of the calcaneum brought up and sutured with chromic 

 catgut (or other) sutures to the sawn surface of the tibia (Fig. 576). 



In bringing up the calcaneum to the tibia it may be found difficult to approxi- 

 mate them without undue tension on the tendo Achillis. To provide against this 

 common difficulty it is customary to place the saw on the upper surface of the calca- 

 neum well behind (a finger-breadth) the joint. Also to dissect back the heel-flap 

 .50 to i cm. (^ to y 2 in.) so that more of the calcaneum can be removed. A 

 larger slice is also taken from the tibia than in Syme's amputation. If the tension 

 remains too great on the tendo calcaneus it is to be divided. 



