TENOTOMY OF FLEXORS OF PHALANGES 131 



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 

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

 and nerves. The vascular bundle lies immediately against 

 the anterior border of the flexor of the third phalanx and 

 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 ves- 

 sels. It is best to make the skin incision far enough pos- 

 teriorly to insure safety to the vessels. First cut down upon 

 the tendon, then incline the handle of the tenotome 

 backward, push the point obliquely forward and down- 

 ward behind and beneath the vascular bundle and then 

 carrying the handle forward, bring the instrument to a per- 

 pendicular position, and force it down along the ante- 

 rior surface of the tendon until it nears the inferior border. 

 Then carry the tenotome handle yet farther for- 

 ward so that the point is directed obliquely backward, to 

 facilitate its passing between the vessel bundle and the ten- 

 don out to the skin.' The invading incision thus describes 

 the segment of a circle, with its concavity 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 which 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 removing the knife and seeing that there is a wide 

 space between the ends of the tendon, the foot is unbound 



