168 DIGITAL NEUROTOMY. 



a short distance inferiorly it passes beneath it, while from 

 the middle of the pastern downwards the nerve lies behind 

 the ligament. 



The operation is practicable at any point over the line of 

 the nerve from the top to the bottom of the shaved area in 

 Plate XXVI or from the superior end of the first phalanx 

 down to a level with the superior border of the lateral carti- 

 lage, but preferably at about the point shown in Plate XXVI , 

 near the superior end of the first phalanx. At the desired 

 point and over the groove betw^een the flexor pedis tendon 

 and the phalanges shave and disinfect an area 4 to 5 cm. 

 square. In the center of this area at the anterior border of 

 the flexor tendon, with the scalpel held perpendicular to 

 the skin, make an incision from above downwards a distance 

 ■of from 2 to 3 cm. cutting cleanly through the skin and 

 subcutaneous fascia down upon the nerve. The incision is 

 favored by tensing the skin between the thumb and index 

 finger of the left hand, but care should be taken not to dis- 

 place it backwards or forwards. Dilate the wound by 

 pressure upon the skin with the thumb and index finger or 

 otherwise and carefully incise longitudinally the fibrous 

 sheath enveloping the nerve and artery. Pass an aneurism 

 needle beneath the nerve, and forcing it upward and down- 

 ward, separate thereby the nerve from the surrounding 

 tissues. Insert a probe pointed bistoury, or scissors beneath 

 the nerve, and divide it at the upper angle of the wound 

 and excise a section 3 cm. long. Disinfect and bandage 

 with or without suturing the wounds. Leave the bandage 

 in place 6 to 8 days. 



