Amputation of the leg is best performed at the place of election, a hand's breadth below the knee-joint. This site is preferred because it gives a sufficient length to the stump below the knee and allows sufficient space below for the instrument maker to place the mechanism of the artificial leg which operates the foot. The sharp projecting edge of the crest of the tibia tends to produce ulceration of the tissues or skin in front of it, therefore it is to be cut off obliquely.

Fig. 565.   Amputation of the upper third of the leg.

Fig. 565. - Amputation of the upper third of the leg.

The fibula, if divided at the same level as the tibia and especially if anteroposterior flaps are used, tends to project too prominently on the outer side, hence it is preferable to divide it at a higher level than the tibia.

The anterior tibial artery is to be sought for on the interosseous membrane close to the tibia with its nerve to the outer side.

The posterior tibial and peroneal are at the same level on the tibialis posterior muscle with the posterior tibial nerve lying superficial to the posterior tibial artery (Fig. 565).