Licence: Public Domain Mark
Credit: Surgical operations / by Sir William MacCormac. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
124/160 page 108
![Operation—Lay the limb on its outer side, with the knee flexed and ankle extended. Make an incision about four inches long in the middle third of the leg (Fig. 88), three-quarters of an inch behind the inner border of the tibia. Take care to avoid the saphena vein. Expose and draw aside the border of the gastrocnemius, then divide the tibial origin of the soleus which is aponeurotic in its interior. As a rule, no muscular fibres are attached to the deep surface of the tendon for half an inch from its insertion. If the muscle be cut through at this point, the space in which the artery is to be found is at once opened. If the incision be made a little more external, there will be a further layer of muscular fibres to divide. Carefully expose and divide the intermuscular septum or deep fascia, covering the vessels. The nerve will first come into view. The artery may then be isolated and ligatured. The operation is easy on the dead subject, but would be far from simple on the living body. This artery, as well as the peroneal artery, may be reached by the so-called bloody operation, i.e. by cutting exactly in the median line through the calf muscles. The incision must then be at least six inches long. Collateral Circulation (Fig. 82), Anterior tibial, internal malleolar \ . , ( Posterior inferior malleolar of ^^'^nch j ^^^^^ ] posterior tibial (Henle.) Pero7ieal Communicating with Posterior tibial beloiv ligature. Muscular with Musnclar of posterior tibial. ( Calcanean branches of pos- Extertial calcanean (Henle) tvith { terior tibial attd external plantar. LIGATURE OF THE PERONEAL ARTERY. Indications.—This operation will very rarely be required. For injury, however, it may have to be performed, and it is necessary to know the position in which to find the artery. Surgical Anatomy.—The vessel is given off about one inch below the lower border of the popliteus muscle, and passes obHquely downwards and outwards towards the fibula, along which it descends. Somewhat](https://iiif.wellcomecollection.org/image/b21979431_0124.jp2/full/800%2C/0/default.jpg)
