ANTERIOR TIBIAL NEUROTOMY 



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extensor pedis longus, EP, Plates XXXII-XXXIII, aud 

 the peronens muscles, P, Plate XXXIII, MP, Plate XXXII, 

 and shave and disinfect an area 6 cm. long by 3 cm. wide 

 directly over this depression and extending upward from a 

 point 6 to 7 cm. above the tibio-astragaloid articulation. 



At a point 8 to 10 cm. above the flexure of the hock make 

 an incision through the skin and subcutis 5 or 6 cm. long 

 over the line of division between the two extensors of the 

 foot. Superficially the operator passes near by the musculo- 

 cutaneous division of the anterior tibial nerve, NMC, Plate 



XXXII, which must not be mistaken for the deep branch. 

 The peroneus muscle, MP, Plate XXXII, and P, Plate 



XXXIII, is separated from the extensor pedis longus, EP, 

 Plates XXXII and XXXIII, by a strong aponeurotic sheath 

 continuous with the tibial aponeurosis. Penetrate the tibial 

 aponeurosis anterior to the aponeurotic partition directly 

 against the extensor pedis, EP, and passing along the 

 posterior border of this muscle to a depth of 2 to 4 cm., 

 there appears the thin margin of the flexor metatarsi 

 magnus, FM, Plates XXXII and XXXIII, which lies im- 

 mediately against the extensor pedis without a visible con- 

 nective tissue partition but revealing itself by a markedly 

 lighter shade of color and its ready separation from the ex- 

 tensor with the scalpel. The deep branch of the peroneal 

 nerve, NP, Plates XXXII and XXXIII, lies loosely im- 

 bedded on the anterior side of the margin of the flexor meta- 

 tarsi facing the extensor pedis, at times visible at the margin, 

 at others placed more deeply reaching in some cases a distance 

 from the margin of 4 or 5 mm. Within this range is seen 

 the slender nerve trunk almost devoid of surrounding con- 

 nective tissue and measuring about 2 ram. in diameter. 

 Pass the aneurism needle beneath it and remove a piece 3 

 to 4 cm. long. Close the cutaneous wound with interrupted 

 sutures and dress antisptically without a bandage. 



