A Manual of the Operations of Surgery, page 29 by Joseph Bell
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uffice to enable the surgeon to check any hæmorrhage of the foot or leg, without it being necessary to burden the memory with the three positions in which to tie the peroneal, or the various methods, more or less bloody and tedious, by which the posterior tibial in its upper third may be secured.
NOTE.--While, as a matter of surgical principle to guide our practice on the living, I still hold very strongly the opinions here expressed against special operations for ligature of the arteries of the leg, and allow the sentences to stand as in the first edition of this work, I insert in a note a brief description of the more important ones, in deference to the advice of friends and the urgent request of pupils, as these operations are used by Examining Boards as tests of the operative dexterity of candidates:--
1. ANTERIOR TIBIAL ARTERY IN LOWER HALF OF LEG.--Anatomical Note.--This vessel is related on its tibial side to the tibialis anticus, and on its fibular, to the extensor longus digitorum above, and the extensor pollicis below. The anterior tibial nerve lies first on its outer side, then crosses the artery, and eventually reaches its inner side near the foot. Operation.--An incision, at least three inches long, parallel with the outer edge of the tibia, and about three-quarters of an inch from it, exposes the deep fascia. This being divided, the outer edge of the tibialis anticus must be found, and will be the guide to the artery, which, surrounded by its venæ comites, lies very deeply between the muscles.
2. Posterior Tibial.--A. In middle third of leg. Here the artery is separated from the inner border of the tibia, by the flexor longus digitorum, and is covered by the soleus. Operation.--An incision at least four inches long, along the inner margin of the tibia, exposes the edge of the gastroenemius; then divide the tendinous attachment, then expose the soleus, and divide its attachment also; the deep fascia will then be seen; slit it up, an