XIII.— THE TREATMENT OF PICKED-UP NAIL. 



Since the commencement of the year I have several times lectured 

 on the treatment of wounds of the lower surface of the horse's foot, and 

 have described to you the methods of treating recent and complicated 

 wounds in each of the parts into which this region has been conven- 

 tionally divided. 



To-day I return to the treatment of grave cases of picked-up nail 

 in the middle zone, in order to study in some detail two modifications 

 which can be made in the technique of the complete operation, and to 

 show you the benefits resulting therefrom. 



I wish to recall to your memory the conditions for which this opera- 

 tion is performed, viz. penetrating wounds, complicated with exten- 

 sive and deep necrosis of the plantar aponeurosis, or with purulent 

 synovitis of the navicular or small sesamoid sheath. 



The complete operation for picked-up nail, as given by Andre and 

 described by Bouley and Trasbot, consists of — (i) a large incision 

 through the plantar cushion ; (2) transverse section of the plantar 

 aponeurosis opposite the posterior margin of the navicular bone, pro- 

 longed on each side as far as the retrorsal processes ; (3) removal of the 

 terminal portion of this aponeurosis ; (4) scraping the lower surface of 

 the navicular bone and that portion of the pedal bone over which is 

 inserted the above-mentioned aponeurosis. 



In 1879 M. Nocard recommended preserving the insertion of the apo- 

 neurosis into the pedal bone by making, opposite the posterior margin 

 of the navicular bone from one lateral lacuna to the other, an incision 

 perpendicular to the median line of the foot, and b}- giving to the two 

 extremities of this incision, from the lacuna to the semilunar crest, a 

 curved or concave form, looking forwards. Retraction of the stump of 

 the tendon is thus avoided. As the tissue composing the plantar cushion 

 granulates more rapidl}' than that of the aponeurosis, it used to be the 

 custom to excise this part very freely, dividing it far back at the boun- 

 dary between its middle and posterior thirds, or even within this, the 

 incision taking an oblique direction from behind forwards. 



Ten years ago I showed that scraping the surface of insertion of the 



