ided or
lengthened. This is best done by the open method.

_Removal of Skin._--To assist in maintaining the desired attitude,
Jones recommends the plan of excising an area of the redundant skin on
the weaker aspect of the limb; in equinus, the skin is taken from the
dorsum; in equino-varus, from the front and lateral aspect of the
foot. When the edges of the gap have united, the foot is maintained in
the desired attitude for some months, even if parents carelessly
remove the iron support to let the child run about.

_Tendon transplantation_, a procedure introduced by Nicoladoni, is to
be considered in children of five and upwards. It may be employed for
different purposes: (1) To reinforce a weak muscle by a healthy
one--for example, by transplanting a hamstring tendon into the patella
to reinforce a weak quadriceps, or reinforcing the weak invertors of
the foot by a transplanted extensor hallucis longus. (2)
Transplantation may also be performed to replace a muscle which is
quite inactive and does not show any sign of recovery--for example,
the tibiales being paralysed, the peroneus longus may be implanted
into the navicular or first metatarsal to act as an invertor of the
foot.

Wherever possible a tendon should be transplanted directly into bone,
as, if it is attached to soft parts it rarely holds firmly enough. The
bone should if possible be tunnelled, and the tendon passed through
the tunnel and securely fixed. When bringing a tendon to its new point
of attachment, it should pass in as straight a line as possible,
avoiding any bend or angle which might impair its action. Fat is the
best medium for the transplanted tendon to traverse, as it acts as a
sheath and prevents the formation of adhesions which would interfere
with the function of the new tendon. All deformity must be corrected
before transferring the tendon; if the tendon is too short to admit of
this, it can be lengthened by means of silk threads (Lange).

According to Jones, the most successful transplantations are the
following, in order: (1) The tibialis anterior into the lateral tarsus
in paralysis of the peronei; (2) the peroneus longus into the
navicular in paralysis of the tibial group; (3) the extensor hallucis
longus into any part of the foot where it may be wanted; (4) the
hamstrings into the patella, to reinforce the quadriceps, provided the
strictest after-treatment can be secured; (5) deflection of part of
the tendo Achillis to one or oth