Operation for the cure of clubfoot / illustrated by explanatory plates, the drawings after nature: being an appendix to a System of practical surgery.

  • Lizars, John, 1787?-1860
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: Operation for the cure of clubfoot / illustrated by explanatory plates, the drawings after nature: being an appendix to a System of practical surgery. Source: Wellcome Collection.

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    the extensor proprius pollicis pedis, and the tibialis anticus, may require to be divided. In talipes calcaneus, the tibialis anticus, the extensor pro¬ prius pollicis, and the extensor longus digitorum require di¬ vision ; the mode of dividing the two former has been already described. The extensor digitorum ought to be operated on im¬ mediately above the anterior annular ligament,—see Anatomi¬ cal Plates, No. XXVI., and this should precede the division of the extensor proprius pollicis, that the latter may protect the anterior tibial artery. In some cases, especially the talipes equinus, there exists con¬ traction of the hamstring muscles, as represented in Plate IV., fig. 6. Here the surgeon must deliberate which tendons and fasciae are concerned. In the instance presented, it is the fascia of the leg, a, the tendo achillis, b, the inner and outer ham¬ string muscles. The patient should rest on a sofa, with his face downwards, and the poples upwards and relaxed; the operator stands on the inner or tibial aspect of the limb to be - operated on ; and the chief assistant grasps hold of the ankle. The fascia, at a, should be first divided, the knife being in¬ serted with its flat surface, at <2, and while an assistant extends the knee-joint, the operator turns the cutting-edge towards the membrane, and with pressure, or a slight cutting motion, di¬ vides the fascia, being careful to avoid wounding the external saphena vein. The fascia is occasionally so extensively con¬ tracted on each side, that the knife must be carried across be¬ tween the skin and it, and the fascia divided on each side. In some instances, the division of the fascia is best done after the cutting of the hamstring tendons ; in this case, the same punc¬ tures answered for both operations. A pledget of lint is to be applied afterwards. Let the operator next divide the tendo achillis, as described in page 7.