DISEASES OF THE LATERAL CARTILAGES 357 



done, there will not be a sufficient thickness left to after- 

 wards bring into position and suture. 



The half-moon-shaped piece of tissue incised is now care- 

 fully dissected away from the external face of the cartilage, 

 until it may be turned up as a flap (see Fig. 141, a), and 

 held from off the cartilage by a tenaculum. 



The exposed cartilage is now carefully removed by the 

 aid of a sage-knife and a stout pair of forceps, the same 

 precaution of holding the foot well forward being again 

 taken in order to avoid wounding of the articular capsule. 



At this stage in the operation considerable care is required. 

 The operator must remember that close beneath him, and 

 more particularly in front, is the pedal articulation. It is 

 better, therefore, to excise the cartilage piecemeal, and to do 

 it carefully, than to attempt, at the risk of injury to the 

 joint, to make the operation ' showy.' 



During removal of the cartilage, the terminal branches 

 of the digital arteries are wounded, as also are the veins of 

 the coronary plexus. Should either of these stand out with 

 extra prominence from the others, it should be picked up 

 with a pair of forceps, and ligatured with either carbolized 

 gut or silk. 



Attention should then be given to the flap of skin and 

 coronary cushion. Wherever a sinus has existed in it, it is 

 to be carefully scraped, and all dead portions of tissue 

 removed. This done, the flap is allowed to fall into position, 

 and is there carefully sutured, not only at the skin of the 

 coronet, but along the whole circumference of the incision. 



Dressing of the Wound and After-Treatment. — The whole 

 secret of the success of this operation is in afterwards 

 maintaining a strict asepsis of the wound. L^nless there is 

 reasonable room for belief that this may be done, the opera- 

 tion had far better not be advised, for if the wound is after- 

 wards suffered to get into a suppurating and dirty condition, 

 the last stage of the case may be worse than the first. 

 Synovitis and arthritis, with certain anchylosis of the joint, 

 and a probable loss of our patient, is almost bound to follow. 



We cannot, therefore, too strongly insist upon the advice 



