NEUROTOMY 137 



shortens most of these operations to the minimum is to grasp 

 one edge of the wound with the dissection forcep, instruct 

 the assistant to bail the blood thoroughly and then make a 

 stroke or two with the knife parallel with the incision, 

 through the areolar tissue covering the underlying struc- 

 tures. This will generally bring the anatomical structures 

 into view for easy identification. If the areolar tissue is 

 bathed with blood it is picked up carefully here and there 

 with the forcep and dissected away with the scalpel. All of 

 the time the assistant is keeping the blood from masking the 

 work. When the nerve comes into sight (and no further 

 step is taken until it is fully identified) it is partially loosened 

 along a small part of one of its edges so as to give a point 

 of entrance for the nerve elevator. The elevator is then 

 taken in the right hand and passed beneath the nerve to the 

 opposite side of the surgical field and held firmly to prevent 

 its disturbance by struggles of the animal, which are quite 

 certain to foHow at this point of the operation. The nerve 

 is then dissected from its adjacent structures along the whole 

 course of the wound and then pulled out with some force as 

 the probe-pointed bistoury divides it at the proximal com- 

 missure of the wound. Dividing it at the distal commissure, 

 sewing the incision and dressing it with appropriate dressing 

 completes the procedure. 



Nerves are sometimes difficult to find and sometimes 

 they are not easily differentiated from the other structures, — 

 aponeuroses, arteries, empty veins, etc. The operator must 

 remember, as a general principle, that nerves are, on the 

 whole, quite superficial, and that failure to immediately lo- 

 cate them is no reason to dig deeply into the wound. Deep 

 digging into the wound leads to more confusing situations 

 than all of the other errors and deficiencies combined. The 

 nerves of horses usually operated upon are not deep. When 

 they are not promptly found it is generally because they are 

 hidden in a mesh of blood-saturated areolar tissue. Always 

 dissect away carefully the superficial areolar tissue with the 

 forcep and scalpel before searching elsewhere for the nerve. 

 By shifting the skin to and fro a very wide range of under- 

 lying tissues can be explored, and these must be thoroughly 

 examined before the dissection is carried deeper. A nerve 

 denuded of its sheath reveals itself in the form of a glistening 

 flattened ribbon, closely blended to an adjacent vein in nearly 

 every instance. After it has been dissected free from its 

 neighboring structures it appears more cylindrical, and may 

 then be mistaken for an artery, which is always round, even 



