Volume 1
A manual of operative surgery / by Frederick Treves.
- Sir Frederick Treves, 1st Baronet
- Date:
- 1891
Licence: Public Domain Mark
Credit: A manual of operative surgery / by Frederick Treves. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
765/795 page 733
![part vi.] AFTER-TREATMENT. material at each changing of the plaster, and that in severe cases the reparative material cannot always be stretched suffi- ciently to overcome the deformity, and it is occasionally necessary to re-divide the tendon. It has been clearly shown that in both the rapid and the immediate methods there is no failure in the uniting material which joins the ends of the divided tendon, nor has the uniting band remained weak or elongated. The possibility of this occurrence has been the main argument in favour of the slow method. The above remarks refer for the most part to infants and children. In dealing with the largest tendons—such as the tendo Achillis in adults—it is desirable still to adhere to the slow method, to allow the limb to remain for some days or a week in the deformed attitude, and then to gradually correct the false position. In not a few instances in which the limb has been adjusted in what may be termed the normal position, after the accidental rupture or division of a large tendon in an adult, the union between the separated ends has been feeble and inefficient. 4. Instruments Used.—Sharp and blunt-pointed tenotomes, with straight blades, are the only instruments needed. These knives must vary, both in size and strength, according to the proportions of the structure requiring division. There should be a mark upon the handle to indicate the position of the cutting edge when the blade is out of view. PARTICULAR OPERATIONS. Tibialis Anticus Tendon.—This tendon descends through the innermost sheath of the annular ligament, and, crossing the ankle-joint, astragalus, scaphoid, and internal cuneiform bones, is inserted into the inner side of the last-named bone and the base of the first metatarsal bone. The synovial sheath which accompanies it extends upwards for some distance above the level of the malleoli. A small bursa lies beneath the tendon as it crosses the cuneiform bone. This tendon is usually divided as it is crossing the scaphoid bone, and consequently about one inch above its insertion.](https://iiif.wellcomecollection.org/image/b21511330_0001_0765.jp2/full/800%2C/0/default.jpg)
