174 VETERINARY SURGICAL OPERATIONS 



Fourth Step. — Search for the Nerve. — When the incision 

 has been advantageously located the nerve will promptly 

 bulge through the incision in the fascia, and thus end the 

 search. Usually, however, the division of the fascia reveals 

 first the brown flesh of the flexor muscles or else the radial 

 vein. These two structures may be mistaken for each other 

 on account of their similarity in color and their roundness. 

 The retractors are then adjusted under the cut edges of the 

 fascia and tension enough brought upon them to expose a 

 wide range of underlying surface. If it does not yield 

 enough to bring the nerve within range it may be incised 

 transversely with the probe-pointed bistoury. When the 

 fascia is thus dilated the nerve is searched out by carefully 

 picking up the masking areolar tissue and dissecting it away 

 here and there as the assistant bails out every vestige of 

 blood. During this dissection the nerve usually appears 

 upon the foreground in the form of a whitish ribbon slightly 

 less than a quarter of an inch in width, closely united to the 

 vein to which it is attached with a loose connective tissue. 

 If the search is still fruitless it is evident that the incision has 

 been made too low, where the median nerve has already 

 curved outward in its descent. In this event the whole in- 

 cision, skin, muscle and fascia, should be carried upward a 

 half inch or more where the nerve is more superficial. 

 Whenever any confusion arises in the search of the nerve 

 there must be no haste to dig deeply in every direction 

 through the surrounding structures, as this course will al- 

 ways terminate disastrously as well as fruitlessly. The 

 median nerve is superficial; it is closely related to the anti- 

 brachial fascia. Searching deeply into the region is, there- 

 fore, useless. Failure to find the nerve may be due to a 

 trivial amount of areolar tissue bathed with blood which, 

 when dissected away, brings the nerve into prominence 

 where it had not been expected. 



Fifth Step. — Elevating the Nerve. — The elevation of the 

 nerve, when found, is not without danger in view of its close 

 proximity to the radial vein. A sharp pointed elevator may 

 easily penetrate the vein and produce a very serious compli- 

 cation in the form of a haemorrhage that is difficult to control. 

 The nerve is elevated by first carefully loosening one o.f its 

 borders from the vein, and then forcing a blunt elevator 

 under it. It is loosened from the vein along the whole 

 course of the wound by simultaneously lifting it with the 

 elevator and breaking down the connecting areolar tissue 

 with the handle of the scalpel. 



