Syme’s tibiotarsal operation, showing part removed and lines of section, before division of malleoli. (Farabeuf.)
[Fig. 702], the complement of [Fig. 701], illustrates the appearance of the stump after the completion of the disarticulation and before the removal of the malleoli.
Pirogoff introduced a serviceable modification by obliquely dividing the os calcis in front of the heel, turning up its sawed surfaces without any dissection of the hood from the heel, and uniting its fresh bone aspect with that made by removal of the articular ends of the leg bones. This would seem to be preferable to Syme’s disarticulation, affording a better walking stump. (See [Figs. 704] and [705].)
A reverse of this operation was suggested by Mikulicz and Wladimiroff, independently, and at about the same time, the heel being excised by an incision across the sole and then behind the ankle, the calcis being divided and its posterior end removed, while the articular surfaces of the leg bones are also removed. The foot is then brought down so that these surfaces can be brought in contact, it being expected that after their reunion the individual will walk in the exaggerated equinus position and upon the ends of the metatarsal bones. The operation is, in effect, an exsection rather than an amputation, and is applicable to but a very small number of cases, in which, however, it sometimes gives excellent results. (See [Fig. 707]).
Fig. 702
Syme’s amputation after disarticulation of the foot at the ankle-joint. The soft parts are being cleared from the malleoli preparatory to sawing the malleoli and lower articular surface of tibia. (Farabeuf.)
Fig. 703
S, line of incision for Syme’s operation; P, line of incision for Pirogoff’s operation. (Erichsen.)