190 VETERINARY SURGICAL OPERATIONS 



metatarsi, in the anterior direction where, of course, no 

 nerve will be found. This diversion in the wrong direction 

 is recognized by the absence of the nerve when the incision 

 is three-quarters of an inch deep. In this step special effort 

 is made not to cut directly into the muscles ; these are only 

 separated with a blunt implement. 



Fifth Step. — Elevating the Nerve. — A Special in- 

 strument facilitates this step. The elevator best adapted for 

 the purpose (Fig. 105) is a long, slender tenaculum with a 

 short, pointed hook. The usual nerve elevator, adapted for 

 shallow wounds, is difficult to pass beneath the nerve, be" 

 cause of the depth and narrowness of the wound. 



The nerve is hooked up with this long tenaculum and 

 then brought to the surface by passing it beneath. 



Sixth Step. — Resecting the Nerve. — Little dissecting is 

 required to free the nerve from its attachments. The ten- 

 sion caused by elevating it from the depths of the wound 

 loosens it from its delicate areolar surroundings. When 

 brought to the surface it is at once found to be perfectly 

 free and ready for resection. 



The resection is carried out as in all neurotomies, with 

 the exception that an artery forcep should first be fixed upon 

 it below the tenaculum, which holds it out of the wound, in 

 order to prevent the distal stump from falling back into the 

 deep wound after it has been divided superiorly. The nerve 

 is slender; it may be even more slender than usual from 

 stretching; if the distal stump is lost in the depths of the 

 narrow wound, some difficulty may be encountered in locat- 

 ing it amid the blood-soaked areolar tissue, and thus the com- 

 pletion of the operation may be unnecessarily delayed. 



Seventh Step. — Closing the Wound.— The wound of per- 

 oneal neurotomy is a difficult one to heal. By dividing the 

 tibial fascia, the subjacent muscles lose their chief support, 

 their chief incarceration, and that at the most prominent part 

 of their bellies. With this support lost, they tend to bulge 

 through the breach and produces a real muscle hernia, 

 whose formation is still further favored by their contractions 

 with every movement of the limb. Sepsis and bursting of 

 the sutures are certain to terminate in the formation of this 

 unfortunate sequel, acting in conjunction with these inimical 

 conditions. 



The closure of the wound is therefore a matter of much 

 importance. It must be effected with special effort to ac- 

 complish a primary union of both the fascia and skin. De- 

 layed cicatrization will always result in formation of miser- 



