374 Anatomy Applied to Medicine and Surgery. 



Li gat ion of the posterior tibial, in the middle 

 third of the leg is rarely called for, and, when it is, is done 

 through an incision about four inches long, commencing 

 about half an inch behind the inner margin of the tibia, 

 avoiding the long saphenous vein and exposing the inner 

 margin of the gastrocnemius which is pulled aside, the 

 soleus is now divided, directing the point of the knife to- 

 wards the tibia, and the deep fascia, which covers the 

 deep muscles and the vessels, is identified. The soleus is re- 

 tracted and the finger feels for the pulsations of the artery 

 near the outer border of the tibia, and, when found, the li- 

 gature is applied. Ligation at the lower third. An incision 

 is made, about two inches long, midway between the inner 

 border of the tendo Achilles and the inner edge of the 

 tibia in the line of the artery. The tendon is retract- 

 ed and the vessel found lying on the flexor longus digi- 

 torum with the nerve to its outer side. The needle is 

 passed from the nerve and the artery ligated. Ligation 

 behind the malleolus. An incision about two inches in 

 length is made, midway between the centre of the convex- 

 ity of the heel and the tip of the inner malleolus. The in- 

 ternal annular ligament is divided and the vessel found in 

 a gap, felt by the finger, between the flexor longus digi- 

 torum and the flexor longus hallucis. The venae comites 

 are separated from the artery and the latter ligated. Col- 

 lateral circulation after ligation of the posterior tibial; the 

 peroneal anastomoses with the posterior tibial by means of 

 the communicating and muscular branches ; the termina- 

 tion of the peroneal, with branches from the external plan- 

 tar of the foot and with the tarsal ; the tarsal and meta- 

 tarsal from the dorsalis pedis, with the external plantar; 

 internal branches from the same vessel, with the internal 

 plantar ; internal malleolar, from the anterior tibial, with 

 branches from the posterior tibial; external malleolar 

 branches of the same artery, with the external plantar. 



