49 



SURGICAL APPLIED ANATOMY. [Chap. xxm. 



become inflamed. The best position, therefore, for 

 bone disease, with reference to the question of exten- 

 sion, would be in the hinder parts of either the 



os calcis or astragalus, 



/ ,,; and one of the worst 



positions would be as- 

 sumed by disease in- 

 volving the scaphoid 

 bone. 



The tarsal bones, 

 from their cancel lous 

 structure and exposure 

 to external influences 

 and injuries, are pecu- 

 liarly liable to become 

 the seat of caries or 

 necrosis. 



Syme's ampu- 

 tation at the ankle. 

 In the heel-flap are 

 cut the integuments, 

 the external saphenous 

 nerve and vein, the 

 peroneus longus, pero- 

 neus brevis, tibialis 

 posticus, flexor longus 

 digitorum, flexor longus 

 pollicis, tendo Achillis, 

 and posterior tibial 

 vessels and nerves. In 

 the dorsal flap are cut 



brevisT'T," peroneus" longus';" X "tendo the integuments, tibi- 

 Achillis; m, some muscles of the sole that i- o^fi^no. ovfone* 

 are not usually left in this operation^.*, &11S ailtlCUS, extensor 



communis digitorum, 

 extensor proprius pol- 

 licis, peroneus tertius, anterior tibial vessels and nerve, 

 musculo-cutaneous nerve, and internal saphenous 



Fig. 57. Syme's Amputation (Agatz). 



a, Tibia; 6, fibula: c, tibialis anticus; d, 

 extensor proprius pollicis ; e, extensor 

 communis digitorum ; f, peroneus tertius; 

 g, flexor longus pollicis; h, tibialis posti- 

 cus ; ?', flexor longus digitorum ;j, peroneus 



are not usually left in this operation ; n, 

 anterior tibial vessels ; o, posterior tibial 

 vessels ; p t posterior tibial nerve. 



