808 INJURIES TO THE KNEE IN THE HORSE. 



wards exactly coincide, forming a straight line. It is advantageous 

 to trace this area in a line inclined obliquely to the long axis of the 

 limb. The ultimate linear cicatrix is then extremely difficult 

 to discover. In this way it is possible to remove scars as large as 

 half-a-crown, leaving a very trifling cicatrix. Larger scars may be 

 greatly diminished, though not entirely removed. 



The operator- makes two parallel curvilinear incisions, meeting 

 above and below the scar as in Fig. 46G. He then dissects away 

 the flap from the underlying tissues, removing at the same time 

 as much of the cicatricial tissue as possible, but taking care not to 

 open the synovial sheaths. The base of the wound should be 

 perfectly flat, and haemorrhage should be stopped by torsion or 

 ligation of the bleeding vessels. If the flap of skin thus removed 

 is so broad as to give difficulty in bringing together the edges of the 

 wound, two lateral incisions may be made (Figs. 466 and 467) in 

 the skin, or the skin may be dissected from the subjacent tissues 

 over the front of the knee. It will then glide easily, and offer much 

 less resistance to coaptation of the edges of the central wound. 



3. When bleeding has ceased the surface of the wound is carefully 

 dried with pledgets of aseptic cotton, care being taken to avoid the 

 formation of blood-clots, which check healing. In a few minutes 

 the wound is dry, and the edges can be brought together with pin 

 sutures, or ordinary interrupted stitches of silkworm gut, each 

 inserted about J inch from the line of incision and about | inch from 

 its neighbour. It is better to commence at, say, the upper extremity 

 of the wound and proceed downwards, than to commence at the 

 centre or at an intermediate point. The surgical knot should be 

 employed. Silkworm gut is the best material for sutures ; it is solid, 

 aseptic, non-porous, does not irritate the tissues, and is readily 

 removed at a later stage. 



4. The wound being perfectly closed is powdered with iodoform 

 covered with iodoform gauze and a large pad of aseptic cotton wool 

 retained in position by tarlatan bandages. The slightly moist tar- 

 latan readily adapts itself to the form of the limb, and is preferable 

 to any other material. Bandaging should commence low down 

 on the cannon bone, and be gradually continued upwards over the 

 knee. 



It being absolutely essential to prevent all movement in the limb 

 after operation, some form of splint is necessary. Plaster bandages 

 have been tried with good effect, but a much simpler and more 

 effective apparatus consists of a " legging " of very stout leather, 

 reinforced by ribs of spring steel and capable of being tightened by 



