The practice of surgery / by James Gregory Mumford ... with 682 illustrations.

  • James Gregory Mumford
Date:
1910
Catalogue details

Licence: Public Domain Mark

Credit: The practice of surgery / by James Gregory Mumford ... with 682 illustrations. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    988/1044 (page 982)
    the line of suture, when {•()ni])leted, .shall not be subject to laterul pres- sure in boot-weai'inii'. Partial Amputations of the Foot.—Ani])utali()ii,s throujih por- tions of the foot have been modified l)y niany surgeons, and various names are given to the various foot amputations. We are coming to the conclusion that most of these amputations through the bones of the foot are objectionable, because the resulting stumps are weak, inconvenient, and painful. Total removal of the foot (at the point of election, 6 to 8 inches below the tibial tubercle) gives the patient a more useful limb. The amputations through the foot are sometimes useful, however, their designated names are classic, and the student should be familiar with their nature. Lisfrancs operation is a disarticulation of all the toes at the tarso- metatarsal joints—so obvious an operation that the .student of surgical history wonders why an)'' one man's name should have been associated with it. Lisfranc's operation is performed with a short dorsal and a long plantar flap—in other words, the .sole of the foot is dissected off and turned up over the stump. The surgeon seizes the toes with his left hand and begins his incision just behind the base of the fifth meta- tarsal bone. He carries the cut straight along the outer aspect of the foot for about an inch, and then rounds out to the dorsum, crossing the foot to its inner edge, and carries his knife back so as to complete the flap just above the cuneiform metatarsal articulation of the great toe, somewhat nearer the plantar than the dorsal aspect. He then forms his plantar flap, which should extend nearly to the tarsophalan- geal joint. The surgeon deepens his cuts, retracts his flaps, and then firmly extends the foot, when the disarticulation is an easy matter. He then removes the tourniquet and picks up the bleeding vessels. I believe it is wise to drain the wound with a rubber wick for twenty- four hours. The stump should be put up in a large elastic compression dres.sing reaching to the knee. The foot should be su])ported on a pillow, or slung in a hammock for at least a week, when healing should be sound enough to permit of the patient's beginning to move about on crutches. Hey's operation is similar to Lisfranc's, except that, in addition to the disarticulation of the metatarsal bones, the end of the internal cuneiform bone is sawed off, so as to provide a smooth and even bone stump. Chopart's operation is a disarticulation of the anterior part of the foot at the mediotarsal joint, that is to say, the astragaloscaphoid joint and the calcaneocuboid joint. The operation provides flaps similar to the Lisfranc flaps, except that they are made somewhat longer and are started opposite the calcaneocuboid joint. Syme's operation—disarticulation of the foot at the ankle-joint. Syme's operation pre.serves the plantar surface and the soft parts of the tip of the heel, which is made to cover the lower ends of the tibia and fibula, whose malleoli are removed. The surgeon makes his incision directly down to the bone from the tip of one malleolus across the sole