156 TENOTOMY OF FEXORS OF PHALANGES. 



ateh' on the anterior border of the tendon insert the teno- 

 tome so far that the point of it can be felt on the lateral or 

 outer side through the skin with the left hand. 



Care is to be exercised in making this invading incision 

 to not include the metacarpal, or metatarsal, arteries, veins 

 and nerves. The vascular bundle lying immediately against 

 the anterior border of the flexor of the third phalanx, it is 

 easy to err by inserting the tenotome in front of the vessels, 

 that is between the suspensory ligament and vessels instead 

 of between the flexor of the third phalanx and vessels. It 

 is safer to make the skin incision far enough posteriorly to 

 insure safety to the vessels, cut down upon the tendon, then 

 incline the handle of the tenotome backwards, push the 

 point of the tenotome obliquely forward and downward 

 behind and beneath the vascular bundle and then carrying 

 the handle forward bring the instrument to a perpendicular 

 position while it is forced down along the anterior surface 

 of the tendon until it nears the inferior border when the 

 tenotome handle should be carried yet further forward so 

 that the point is directed obliquely backward, to facilitate 

 its passing between the vessel bundle and the tendon out to 

 the skin. The invading incision thus describes the segment 

 of a circle, with its concavit}^ backward toward the tendon. 



The cutting edge of the instrument is then turned against 

 the tendon, that is, it is directed backward, the foot is ex- 

 tended by an assistant with the aid of a rope bound around 

 the pastern and looped over the hoof, and the tendon is cut 

 through under light pressure, the operator pressing the 

 handle of the knife forward and downward, using the meta- 

 carpus or suspensory ligament as a fulcrum upon w^hich the 

 back of the tenotome rests as a lever. A loud cracking, as 

 well as the disappearance of resistance to extension shows 

 that the tendon has been severed. 



After the removal of the knife and seeing that there is a 

 wide space between the ends of the tendon, the foot is un- 



