82 CLINICAL VETERINARY MEDICINE AND SURGERY. 



surgery. To avoid excessive cutting, and to reduce as far as possible 

 the extent of the wound, one may depart from the rule ; and if the sinus 

 is in one of the lateral lacunas, far enough removed from the point of 

 the sensitive frog, if necrosis is limited to one half of the aponeurosis, 

 or is situated near one of its margins, you may make the transverse 

 incision through the aponeurosis and plantar cushion more or less 

 oblique to the long axis of the foot, and thus, while removing the whole 

 of the necrotic patch, preserve on the opposite side the larger propor- 

 tion of the healthy tissues. 



By lifting the end of the aponeurosis with the flattened end of a 

 director or any blunt object, it becomes easy to separate the cartilaginous 

 material surrounding the navicular bone with a button-pointed knife, 

 or a cautiously handled sharp-pointed knife. In practice, therefore, it is 

 sometimes advisable to depart from the rules of the classical operation. 

 Different cases require different treatment, and it is always important to 

 preserve tissue as far as possible. 



With the advent of antisepsis the surgery of the foot has become 

 more conservative. In complicated injuries of the plantar region, in 

 particular, we should endeavour to reduce the operative wound to the 

 smallest dimensions. 



Let us now consider the treatment of necrosis of the plantar 

 aponeurosis, occurring close to the synovial cul-de-sacs in the flexure 

 of the pastern. In this region necrosis is very common as a result of 

 suppurating corns, or of foreign bodies having passed through the 

 central zone in an oblique direction upwards and backwards. In operat- 

 ing for such injuries, excision of the entire eschar would expose us to 

 the risk of opening the synovial cul-de-sacs of the pedal joint and of the 

 great sesamoid sheath. Those of you who have been present at my 

 operations for picked-up nail know how I proceed under such circum- 

 stances. After removing all tissue which can be taken away without 

 injuring these synovial sacs, I form a counter-opening in the flexure of 

 the pastern. After preparing the pastern region, shaving away the 

 hair and disinfecting the skin, I introduce the special "sage-leaf" 

 shaped knife at the bottom of the wound at the spot where I have been 

 obliged to leave a necrotic or doubtful piece of tissue, and from this 

 point push it upwards and backwards between the aponeurosis and 

 plantar cushion (keeping close to the former) until it emerges above the 

 bulb of the heel.* If necessary I enlarge the opening by guiding the 

 knife along a hollow director. Then I pass a piece of gauze to act as a 

 drain, saturate the suspected portion on the stump of the tendon with 



* The procedure is precisely similar to that in passing a frog-seton. — Jno. A. W. D. 



