PERONEAL NEUROTOMY 189 



with mercuric, chloride solution 1-500, and then finally with 

 alcohol. In order to still further combat sepsis, the field 

 thus cleansed may be sprinkled and rubbed with boric acid 

 and iodoform, portions of which are allowed to remain in the 

 recesses of the shaved integument. 



Third Step. — Incising the Skin and Fascia. — An in- 

 cision is made two inches long along the line decided upon, 

 regardless of the veins which are often seen to traverse the 

 seat in different directions. These veins are subcutaneous. 

 They should be exposed without cutting them in making 

 the incision through the skin, and then picked up and twisted 

 with the forcep to prevent blood from saturating the wound. 

 When these vessels are disposed of, the underlying tibial 

 fascia is incised with the probe-pointed bistoury, an entrance 

 point for which is made at the distal end of the wound. 

 These two incisions, which expose brownish-red muscles 

 beneath, should be rendered perfectly bloodless before pro- 

 ceeding to the next step ; otherwise the search for the nerve 

 will be greatly impeded by the constant flow of blood into 

 the depth of the wound. 



Fourth Step. — Separating the Exterior Pedis from 

 the Peroneus Muscles and Searching for the Nerve.— After 

 the tibial fascia is divided, a second fascia is encountered. 

 This one surrounds the anterior tibial group of muscles. 

 Before it is divided, the division between the muscles cannot 

 be found, but when incised with the probe-pointed bistoury, 

 the handle of the scalpel can easily be carried between them,, 

 as they-are attached to each other with only a loose areolar 

 tissue. The two tenacula are now hooked into the muscles 

 on either side of the wound, as the handle of the scalpel gently 

 breaks down the areolar tissue connecting them. This break- 

 ing down process with the handle of the scalpel is carried 

 about three-quarters of an inch deep. Then as the tenacula 

 widen the space, the muscles are pressed first to one side and 

 then to the other, with the handle of the scalpel, while the 

 eye searches the depth of the wound for a slender, whitish 

 cord lying flush against the anterior wall of the wound. This 

 cord, — the peroneal nerve, — is no larger than the size of a 

 small straw, but it is easily seen against the brownish-red 

 back-ground, if there is no blood to mask the surface. When 

 it is not promptly seen, the incision is not immediately deep- 

 ened. Instead, the muscles are pressed to and fro with the 

 handle of the scalpel, until the part related to the nerve is 

 rolled into view. Sometimes the dissection of the muscles 

 is accidently carried between the extensor pedis and flexor 



