METACARPAL TENOTOMY 209 



At this time the tendons will have reinforced themselves suf- 

 ficiently to perform their weight-carrying function unaided. 

 A blister or firing with the feather-edge iron, and finally a 

 rest at pasture or in a paddock for one or two months, com- 

 pletes the procedure. 



ACCIDENTS AND SEQUEL^.— In dividing the flex- 

 ors of the phalanges special care is taken to prevent pyogenic 

 infection. An accumulation of pus between the divided ends 

 of the tendons may spread into the neighboring synovials 

 and terminate in -a serious complication. The prevention is 

 found in performing the operation with sterilized instru- 

 ments after having thoroughly cleansed the field. 



An exaggerated dorsal flexion may result from failure 

 to apply an adequate supporting bandage. The fetlock de- 

 scends almost to the floor and the toe turns upward at every 

 step. 



Induration of the tendons at the seat of operation is an 

 inevitable and unavoidable sequel. The operation always 

 leaves an indelible hard tumefaction at and around the seat 

 of operation. This sequel is not important in view of the 

 much greater deformity which preceded it. The firing and 

 blistering limits the size of the indurated tumefaction some- 

 what, but no form of treatment will entirely eliminate it. 



During the operation there is always some danger of 

 severing the great metacarpal artery and vein. This accident 

 is certain to be followed by a very troublesome oedema of 

 the leg. Prevention is found in operating on the internal 

 side of the leg and by passing the bistoury safely beneath the 

 vessels. 



Recurrence of the Deformity. — Volar flexions straight- 

 ened by tenotomy do not always remain permanently cured. 

 In view of the fact that they are caused by primary lesions 

 that are not benefited by the operation, a recurrence of the 

 deformity may be often expected. The cure is permanent 

 only when the causative lesion is no longer active. The 

 supposition that tendons shorten again on account of the 

 contraction of the cicatricial tissue that fills up the space be- 

 tween the divided ends is not true. It is the initial lesion 

 that governs their future behavior. If this lesion is cured the 

 tenotomy will be a pronounced success, otherwise recurrence 

 of the deformity may occur to a greater or lesser degree, 

 dependent upon the amount of pain accompanying the le- 

 sion. 



