He then repeats this incision on the other side, makes tense the ligaments, first at one side and then at the other, by drawing the finger to the opposite side, and cuts them. The tendons being cut, the finger is detached. The vessels being tied, one point of suture is put in on the dorsal aspect, and the fingers on each side tied together at their extremities, with a pad of lint between them. _Modification._--Lisfranc's method is too long in its minute description to give in detail. The principle is to make a semilunar flap at one side (the one opposite the operator's right hand), by cutting from without inwards, then to open the joint from this cut, and, still keeping the edge of the knife close to the head of the phalanx, cutting the other flap from within outwards. This can be very rapidly done, but the last flap is apt to be irregular and deficient, especially in those common cases, in which, after whitlow or the like, the tissues are hard and brawny, and the skin does not play freely. It is quite unnecessary to remove the head of the metacarpal, either for the sake of appearance, or to render healing more rapid, and its removal weakens the arch of the hand; where the cartilage is eroded by disease, the cartilage-covered portion can be scooped off by a gouge or removed entire by pliers, without interfering with the broad end to which the transverse ligament of the palm is attached. If required either for injury or disease, the metacarpal head may be easily removed by a single straight incision from the knuckle upwards, as far as the point at which it may be deemed necessary to saw it through, or better still, divide it with the bone-pliers. This incision should be made as a first step in the first incision for amputation of the finger, and the finger should not be disarticulated, but kept on, to aid by its leverage in separating the metacarpal head. _Amputation of the index or little fingers._--This operation differs from the preceding only in this, that care must be taken to make a good large flap on the free side of each; making the incision, which begins at the knuckle (Fig. I. 4), enclose a well-rounded flap, and not allowing it to enter the palm till it reaches the level of the web between the fingers. The metacarpal heads may here be cut obliquely with the bone-pliers, to prevent undue projection. _Amputation of one or more metacarpals._--These operations may be rendered necessary by disease or injury. If the latter demands their performance, no rules can be given for incisions or flaps, they must just be obtained where and how they can best be got. If for disease, a single dorsal incision (Fig. I. 5) over the bone will allow it to be dissected out of the hand. _N.B._--In no case, except that of the thumb, should any attempt be made to save a finger while its metacarpal is removed. (See _Excisions of Bones_.)