BILATERAL AND UNILATERAL PLANTAR NEUROTOMY 149 



more danger of making it too far anteriorly, than too far 

 posteriorly, because the nerve is located posterior to the 

 vein. If the incision is made so as to carry the wound 

 in front of the vein, confusion immediately arises be- 

 cause no. landmarks are disclosed in the subsequent dis- 

 section, but if made so as to bring the wound immediately 

 behind the vein, the nerve will promptly come_ into the fore- 

 ground. The aim should be to make the incision about two 

 millimeters posterior to the center-line of the vein. The 

 proximo-distal location varies according to circumstances. 

 For the great majority of cases a certain location, just above 

 the fetlock, at the very point where the round contour of the 

 perforans tendon becomes indistinct, may be universally 

 selected. Sometimes, however it must be made higher on 

 account of some abnormality at the usual point. A large 

 windgall, or a large cicatrix from interfering, will necessitate 



Fig. 91— Highest Position of Incision in Plantar Neurotomy. The Elastic 



Retractor Applied. 



a higher location; and again, when the operation is decided 

 upon for a lesion some distance above the foot, a higher 

 division of the nerve may be thought expedient. When the 

 high location is decided upon the lower part of the middle 

 third of the metacarpus is selected as the most appropriate 

 spot. Here, where there are no synovials to injure, the 

 nerve can be found quite as easily as at any other point 

 except at the one already described, just above the fetlock, 

 where the nerve is located by palpation. 



Second Step.— Preparing and Disinfecting the Field— As 

 the wound in this operation occupies a rather conspicious 

 position on the leg, special effort should be made to heal 

 it with an invisible cicatrix. The preliminary requisite 

 to such a result is a painstaking effort to disinfect the field 

 adequately. It is advisable to clip and shave a rectangular 

 space one and a half inches long and one inch wide around 



