PERONEAL NEUROTOMY 185 



the wound with the nerve elevator. Oftimes the posterior 

 tibial vein sends one or more branches backward, which may 

 easily be wounded while releasing the nerve from its encase- 

 ment along the course of the incision. 



Fifth Step. — Resecting the Nerve.— The elevated nerve 

 is stretched by means of an elevator, and then quickly 

 snipped off superiorly with the probe-pointed bistoury, after 

 which the stump is picked up with the artery or dissecting 

 forceps and divided inferiorly. About two inches of the 

 trunk should be resected. 



Sixth Step. — Closing the Wound. — The wound is closed 

 with interrupted sutures, special care being taken to bring 

 the edges of the skin into perfect apposition throughout. 

 The edges of this wound are very liable to fold inward un- 

 less special care is taken to arrange them properly. Drain- 

 age is not necessary. 



AFTER-CARE. — The wound of tibial neurotomy should 

 be protected with a plastic dressing, either collodion or cal- 

 careous clay, which is not disturbed until the edges have 

 united, six or seven days later, at which time the stitches are 

 removed. The patient is kept in the standing position at all 

 hazards, in order to protect the edges of the wound against 

 the friction and tension produced by curving the leg beneath 

 the body, and by getting np and down. After twenty days 

 the patient may be returned to work, but a longer rest at 

 pasture is advisable. The hoof must henceforth be protected 

 against nail pricks, treads, etc., and the pasterns and fetlock 

 against scratches and interfering wounds. But above all the 

 patient's occupation must not be arduous. Hard or fast 

 work will sooner or later cause dissolution of the hoof or 

 fetlock. 



Peroneal Neurotomy. 



SYNONYMS. — Anterior tibial neurotomy; deep peron- 

 'eal neurotomy. 



DEFINITION. — Peroneal neurotomy is the resection 

 of a part of the anterior tibial ner-ve in the middle third of 

 the tibial region.' 



DISTRIBUTION OF THE ANTERIOR TIBIAL 

 NERVE. — The anterior tibial or deep peroneal nerve is a 

 radicle of the femoro-popliteal branch of the sciatic. It 

 leaves the parent trunk at the upper third of the tibia after 

 the latter has passed diagonally across the external surface 

 of the tibia. On its course down the leg it occupies the space 

 between the bellies of the extensor pedis and peroneus 



