228 VETERINARY SURGICAL OPERATIONS 



anient. — The wound is widened with the retractors, and as 

 soon as the bleeding no longer hinders, the edges of the liga- 

 ment near its tibial insertion are searched out by cautiously 

 dissecting the areolar tissue and fascia. The fascia is thick 

 and closely blended with the ligament itself; in fact they are 

 inseparable. It is impossible to lift the fascia from the liga- 

 ment so a"s to expose it. They must be managed as a single 

 structure. The edges are sought directly through the fascia, 

 where by palpation it is found to be thin and devoid of the 

 thick underlying fibrous tissue — (the ligament itself). The 

 search for these two lateral edges is limited to the inferior 

 part of the wound, where a thick pad of adipose tissue inter- 

 posed between the ligament and the capsular ligament acts 

 as a perfect protection against wounding the latter. Higher 

 up the capsular ligament is so closely related to the ligament 

 as to render their separation quite hazardous. 



Fourth Step. — Dividing the Ligament. — When the edges 

 have been thus exposed the probe-pointed bistoury is passed 

 flatwise under the ligament from before backward, keeping 

 its blunt point against the ligament rather than plunging it 

 inward. When its point appears at the opposite edge of the 

 ligament the blade is turned upward and the ligament cut 

 off at a single stroke. If the cut ends do not at once separate 

 at least a quarter of an inch it is evident that some of the 

 fibers of the ligament on one side or the other have not been 

 divided and will require subsequent attention. These few 

 fibers are divided by carefully passing the -bistoury under 

 them first on one side and then another until the breach be- 

 tween the cut ends widens sufficiently to indicate complete 

 solution of continuity of every part of the ligament. 



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

 with three to five interrupted stitches so adjusted as to as- 

 sure perfect apposition of the wound from end to end. Drain- 

 age is not indicated except when found necessary to deal 

 with an accidental septic state a few days later. The sutures 

 are closed with an impervious dressing of collodion or cal- 

 careous clay. If there is any blood flowing or oozing from 

 the incision the dressing is postponed until the standing po- 

 sition is regained and all of the flow has ceased. 



AFTER-CARE. — The wound is given the usual treat- 

 ment for wounds requiring no drainage, i. e., renewal or re- 

 pair of the dressing as required and the removal of the 

 stitches at the end of six or seven days. Except in the case 

 of a suckling it is advisable to keep the patient standing until 



