KNUCKLING, 519 
skin of the opposite side; while there slowly pull it away from the tract it 
has made; the curved tenotome is then introduced in its place and its 
sharp edge brought in contact with the perforans. Taking a point of 
support with the thumb on the anterior face of the canon, the section of 
the tendon is made by a very limited sea-saw motion of the hand, while at 
the moment of the division the assistants are pulling on the ropes at the 
foot and at the knee in different directions, that of the foot forward, the 
other backward. With care, the skin is seldom cut more than the point 
of introduction of the tenotome. If double tenotomy is performed, 
divide the perforans first, then pass the tenotome behind the perforatus 
and divide it as the perforans was. The division from forward backwards 
exposes a large incision of the skin; clean up the region, close the cuta- 
neous wound with collodion and apply a slightly compressive bandage. A 
bloody extravasation fills up the space left between the extremities of the 
tendon, the surrounding connective tissue becomes inflamed and a piece 
of embryonic tissue is soon formed. The swelling, first warm and painful, 
gradually diminishes and indurates. After two months, the newly formed 
tissue has obtained sufficient resistance to allow resuming work. After- 
wards, like all cicatricial tissue, a more or less marked retraction takes 
place and for a long time it is the seat of an abnormal sensibility which 
interferes with the motions of the animal or lames the horse. 
The accidental section of one of the nerves of the canon is of no im- 
portance ; wound of the artery, very rare, demands the application of a 
compressive bandage. More serious is the opening of the carpal, tarsal 
or sesamoid sacs—which can occur only with those lacking anatomical 
knowledge. Simple cleanliness prevents the suppuration at the traumatic 
center. ; 
As remarked by Bouley, the work of cicatrization of one or the other of 
the tendons is always followed by their intimate and lasting union. The 
perforans and perforatus are solidarized, the mechanism of the ring of the 
perforatus is destroyed ; now the phalanges, almost immobile upon each 
other, do not flex any more, and the horse is always liable to stumble 
and fall. He can no longer be utilized to fast gait, so much so that the 
neoformed structure remains always more vascular, more sensitive and 
more exposed to dilacerations than the normal fibrous tissue. However, 
tenotomy allows some horses to be used which otherwise would have 
remained unfit for work. 
It is not the case, however, that successful results obtained by tenotomy 
remain always lasting, even where the cause of the knuckling has been 
properly treated. Against relapse, blistering and firing applied on the 
retracted cicatricial tissue have been recommended. A second tenotomy 
is the only thing to replace the leg in its proper position; but, from an 
economical point of view, it is not advisable, 
