OPERATIONS UPON PIBKOTJS TISSUES. 317 



operation, does not involve as many objections as at first thought, 

 but, on the contrary, has often been followed by very satisfactory 

 results. It is, therefore, a justifiable operation when the defor- 

 mity of the fetlock is quite extensive. In fact, it is unavoidable 

 when both tendons are united, or when the deviation in the di- 

 rection of the bony levers is caused equally by the common con- 

 traction of both. In performing this double tenotomy, the divis- 

 ion of the deep flexor being made by the manipulations already 

 described, the curved tenotome being stiU retained in the wound 

 between the tendons, the operator simply reverses its position in 

 order to bring the cutting edge in contact with the superficial 

 tendon, and completes the operation precisely as already described. 

 In this division of the tendon great caution must be observed, in 

 order to avoid making a complete transverse section of the skin. 

 Double tenotomy is also performed in some cases by introducing 

 the tenotome between the suspensory ligament and the tendons, 

 and dividing them by a section made at once through both from 

 before backward. 



In some peculiar cases, besides the division of the two tendons, 

 that of the suspensory ligament has also been included, sometimes 

 in connection with the tenotomy, and sometimes independently. 

 In this case, the place selected differs from that which is indicated 

 for the simple or double operation. It is, indeed, toward the lower 

 extremity near the bifurcation, and toward the lower third of the 

 cannon, where it is more readUy reached. The straight tenotome 

 is first introduced, flatwise on either the internal or external face 

 of the leg, between the Ugament and the deep flexor of the pha- 

 langes, carefully avoiding the blood vessels and nerves, and the 

 curved instrument is inserted with its cutting edge toward the 

 ligament, the section being made by cutting from behind forward. 

 The instrument must not be introduced between the bone and 

 the Ugament, nor must the section be made from before back- 

 ward ; such a course not only endangering the nerves and blood 

 vessels, but also involving the risk of breaking the blade of the 

 tenotome at the bottom of the wound. 



Whatever mode may have been followed, and however many 

 tendons may have been divided, or whatever force may have been 

 applied to the rope by the assistants who made the traction, it is 

 an exceedingly rare result to obtain a perfect straightening of the 

 leg, most especially when the disease has been of long continu- 



