RADICAL OPERATIONS FOR QUITTOR 



323 



The picture presented by the lateral cartilage affected 

 with quittor is variable. Generally at one point it will pre- 

 sent a green colored area surrounded by a marble-white field, 

 indicating the extent of the necrotic process. The green 

 portion may be exceeding small or it may be quite extensive. 

 In some cases, pieces of cartilage surrounded by granula- 

 tions are found detached, from the main body, and in old 

 quittors it may be difficult to identify the cartilages as such. 



Other methods require a tedious separation of the inner 

 surface of the cartilage from its underlying attachments, 

 which cannot be done without causing some anxiety for the 



Fig. 157— Second Step of Bayer's Operation for Quittor. A, Flap. 

 B, Lateral Cartilage. C, C, Laminee. D, D, Coronary Cushion. 



safety of the capsule of the pedal articulation and the sheath 

 of the perforans tendon. 



Fourth Step. — Suturing the Flap. — The flap, which now 

 fits somewhat loosely over the excavation, is sutured from 

 end to end, special care being taken to neatly approximate 

 the skin and coronet posteriorly. The laminae are consti- 

 tuted of very delicate tissue that tears easily with threads, 

 and as a consequence these should be drawn together with 

 great caution. Interrupted sutures are preferable. Catgut 

 has no advantage over silk, as absorption of the suture is 

 not essential to the success of the procedure. 



Fifth Step.— Application of the Protective Dressing.— 



