Chap, xxiii.i THE ANKLE AND FOOT. 491 



nerve and vein. The position of the principal struc- 

 tures divided is shown in Fig. 57. It is not usual 

 to dissect up any of the muscular tissue of the sole 

 as shown in Agatz's plate. 



It should be noted that the integuments of the 

 heel derive their blood-supply, which is very free, 

 mainly from the external calcaneal branch of the 

 posterior peroneal artery, and the internal calcaneal 

 from the external plantar. The supply of the part is 

 also aided by branches from the tarsal artery, by the 

 internal malleolar branch of the posterior tibial, and 

 the outer and inner malleolar vessels from the anterior 

 tibial trunk. 



The nerves supplying the integuments of .the heel 

 are the calcaneal branch of the external saphenous 

 and the calcaneal and plantar cutaneous twigs from 

 the posterior tibial. 



In PirogoflPs amputation, the parts divided 

 in the anterior flap are the same as in Syme's opera- 

 tion. In the heel or sole flap the same structures 

 also are cut as in the corresponding flap in a Syme, 

 with the exception that the tendo Achillis is not 

 divided, the flexor brevis digitorum, abductor pollicis, 

 abductor minimi digiti, and flexor accessorius are cut, 

 and the plantar vessels and nerves are divided in the 

 place of the posterior tibial. 



Cliopart's operation, an amputation at the 

 medio- tarsal joint. In the dorsal flap are cut the 

 integuments, the extensor communis and brevis digi- 

 torum, extensor proprius pollicis, tibialis anticus, 

 peroneus tertius and brevis, the musculo- cutaneous, 

 anterior tibial, and two saphenous nerves, the dorsal 

 artery, and the dorsal plexus of veins. In the plantar 

 flap are found divided the integuments, plantar fascia, 

 flexor brevis digitorum, abductors of the great and 

 little toes, flexor accessorius, and tibialis posticus 

 tendon. If the flap be well dissected up from the 



