CARPAL TENOTOMY 201 



the view of preventing abscess. The space between the cut 

 ends of the tendons fills with blood clot and leaves a favor- 

 able field for the growth of micro-organisms, which might be 

 accidentally carried into these recesses from a dirty skin. 

 Furthermore, purulent products will burrow between neigh- 

 boring structures and cause serious complications. Absolute 

 cleanliness is therefore specially essential. 



Third Step. — Making a Point of Entrance for the Bis- 

 toury. — The point of the scalpel is plunged firmly through 

 the skin and subjacent fascia. The knife is held firmly be- 

 tween the fingers, and the hand is pressed flush against the 

 leg, so that a sudden jerk will not slash a large opening in 

 the skin. The point of entrance is made just large enough 

 to admit the bistoury, and no larger. With a gaping wound 

 at this location, subsequent infection of the deeper recesses 

 could hardly be prevented. 



Fourth Step. — Dividing the Tendons.— The probe- 

 pointed bistoury is now passed through this small incision, 

 between the two tendons, until its point is on a level with 

 their deepest part. Its- cutting edge is turned against the 

 external tendon and the handle is then grasped firmly, 

 the other hand acting as a guard externally. The as- 

 sistants who are holding the leg pull with their might 

 to stretch the tendon, as a deliberate sweep of the bistoury 

 snaps it off. Then, without removing the bistoury, its cut- 

 ting edge is turned against the medius, which is divided in 

 exactly the same manner. The only special precaution to 

 take in this step is that of not passing the bistoury too deep. 

 The posterior radial artery, and the superior cul-de-sac of 

 the carpal sheath, may thus be unnecessarily wounded. 



Fifth Step. — Bandaging. — A thin layer of cotton soaked 

 in an antiseptic is placed over the wound and a firm muslin 

 bandage wound over the region, including the upper third 

 of the metacarpus and the lower third of the radius. 



AFTER-CARE.— The patient is kept in the standing 

 position for several days. The bandage is changed daily to 

 prevent discomfort from pressure. At the end of the week 

 the patient is turned into a loose box, paddock or pasture, 

 and allowed at least six weeks of rest. 



SEQUELS AND ACCIDENTS.— Septic inflammation 

 of the surgical wound, which may spread into the adjacent 

 synovials, is the most serious consequence of the operation. 

 If guarded against by cleanly methods of operating, it will 

 seldom occur. The radial artery may be accidentally cut by 

 passing the bistoury too deep between the tendons, but the 



