158 ANTERIOR TIBIAL NEURECTOMY 



Technic. Confine as in the preceding but with the affected 

 leg uppermost. lyocate the furrow dividing the extensor 

 pedis longus, EP, Figs. 58, 59, and the peroneus muscles, P, 

 Fig. 58, MP, Fig. 59, and shave and disinfect an area 6 cm. 

 long by 3 cm. wide directly over this depression and ex- 

 tending 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, 

 Fig. 58, which must not be mistaken for the deep branch. 



The peroneus muscle, MP, Fig. 58, and P, Fig. 59, is 

 separated from the extensor pedis longus, EP, Figs. 58, 

 59, 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. 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, Figs. 58, 

 59, which lies immediately against the extensor pedis 

 without a visible connective tissue partition but reveals it- 

 self by a markedly lighter shade of color and its ready 

 separation from the extensor with the scalpel. The deep 

 branch bf the peroneal nerve, NP, Figs. 58 and 59, lies 

 loosely imbedded on the anterior side of the margin of the 

 flexor metatarsi 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 connective tissue and measuring 

 about 2 mm. 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 antiseptically 

 without a bandage. 



