THE TREATMENT OF PICKED-UP NAII,. 79 



aponeurosis is superfluous, and that under an antiseptic dressing the 

 fibrous tissue left covering the os pedis, far from undergoing necrosis 

 (as had been suggested), rapidly becomes vascular and covered with 

 granulations, like the other tissues in the wound. Even where necrosis 

 has affected a portion of the end of the aponeurosis, you have always 

 seen that I limited remo\al of the fibrous la3'er and scraping of the bone 

 to that particular portion. 



By thus preserving the fibrous covering of the pedal bone o\-er the 

 entire surface of insertion of the perforans tendon, operation is simpli- 

 fied — scraping being a delicate process, which endangers the interosseous 

 ligament, — the chance of arthritis is less, and the anterior portion of the 

 wound fills up more rapidly than after curetting the semilunar crest. 



But in consequence of the obliquity with which the plantar cushion 

 is divided, especially when the necrotic portion of the aponeurosis 

 extends to or a little behind the posterior margin of the navicular bone, 

 the operation wound is very large, sometimes almost alarming in size ; 

 and healing, even when uncomplicated, occupies a long time — some six 

 to eight weeks. The majority of patients only return to work after 

 extended rest. 



Whatever the position of the necrosis or of the penetrating wound 

 in the navicular sheath, the period of healing and consequently the 

 required rest may be diminished by sparing, as far as possible, the 

 plantar cushion, and reducing to a minimum the loss of substance b}- 

 making the primary incision at right angles to the surface of the plantar 

 region, or even inclined a little obliquel}- from in front backwards. 

 Antiseptic treatment and plugging of the wound with gauze prevents 

 the complications which caused older operators to excise the plantar 

 cushion so freely. You will at once see the advantages of this method, — 

 more rapid closure of the operative wound, and a smaller cicatrix, the 

 tenderness of which is sometimes the only reason for lameness persist- 

 ing ; in a word, more rapid and complete reco\'ery. 



You have been able personally to estimate these advantages in a 

 certain number of our cases. I may repeat to you the histor}- of the 

 most recent. 



On the 15th March last a heavy seven-)-ear-old cart mare entered 

 hospital. Three weeks before she had picked up a nail about the 

 centre of the left hind foot. The nail had penetrated perpendicularly 

 into the internal lacuna, not far from the limit between the middle and 

 posterior zones. A veterinary surgeon had thinned the sole around the 

 wound, which he had laid open and disinfected, and had afterwards 

 covered the parts with an iodoform dressing. Despite this treatment 

 the wound became complicated. Towards the end of the second week 



