l6o NEUROTOMY OF THE MEDIAN NERVE. 



3 to 5 cm. long, the lower angle of which is just above the 

 fetlock joint, cutting directly through the skin, subcutem 

 and connective tissue sheath down onto the nerve, laying 

 it bare. The borders of the cutaneous wound are held apart 

 with tenacula and by palpation with the fingers or by vision 

 it is determined if the nerve lies in the middle of the wound. 

 If necessary continue the dissection with the scalpel until 

 the nerve is clearly revealed ; if-is distinguished by its faint- 

 ly yellowish color, its fine longitudinal striae and its location 

 behind the metacarpal artery. Immediately above the fet- 

 lock joist the median metacarpal or metatarsal nerve divides 

 into an anterior smaller, d, and posterior larger branch, o. 

 This division should be laid bare in order that the operator 

 may not erroneously cut one branch only. Immediately 

 above this point of division the aneurism needle is passed 

 under the nerve, then a second instrument is inserted beside it 

 and the two pulled apart separating the nerve from the ad- 

 jacent tissues, the scissors or a small probe-pointed bistoury 

 is passed beneath and it is cut through quickly at the superior 

 angle of the wound.' The distal end of the nerve is then 

 dissected free downward and both branches excised at the 

 lower angle of the wound so that a section 3 to 5 cm. long 

 is removed. The cutaneous wound is united by a continuous 

 suture and a temporary bandage applied. If the horse has 

 been secured by casting, the extension splint, if it has been 

 used, is then removed, the foot replaced in the hobble and 

 the horse turned to the other side. The QEeralion on the 

 opposite metacarpal nerve is carried out in the same way 

 after which a sterile bandage is applied and allowed to re- 

 main eight days. Healing by primary union. ^ 



39- NEUROTOMY OF THE MEDIAN NERVE. 

 Pi,A.TE XXVII. 



Objects. The relief of lameness due to disease so located 

 in the anterior hmb that it cannot be overcome by plantar 

 neurotomy. 



