Amputations Of the Leg.
—Modern prosthetic methods have materially changed the indications in amputating the leg. The pressure in artificial limbs is not borne upon the end of the stump, but is rather circumferential and borne by a conical socket. It is now, therefore, an object to preserve as much of the limb as practicable, in order to have better leverage or control of the artificial member. Consequently the point of election is now the middle of the leg, unless the amputation may be made even below this point. The objection to a short leg stump is the inevitable flexion which the hamstring flexors will produce; in such cases the pressure will be borne upon the knee, while the appearance of the stump is by no means ideal. If, therefore, one is forced to make a high amputation of the leg it would be far preferable to make a good knee disarticulation, or, better still, a supracondyloid amputation, with preservation of the patella, thus furnishing a stump which affords perhaps the only exception to the general rule, i. e., that weight cannot be borne upon the stump end.
Fig. 704
Skeleton of stump after Pirogoff’s osteoplastic amputation. The sawed surface of the calcaneum in apposition with divided surface of tibia. (Farabeuf.)
Fig. 705
Stump after Pirogoff’s operation. The weight of the body must rest upon the thick plantar skin of the heel and never on the thin skin of the retrocalcaneal surface. (Farabeuf.)
Fig. 706
