1 84 , ANTERIOR TIBIAL NEUROTOMY. 



At a p^at 8 to lo cm. above the flexure of the hock make 

 an incision through the skin and subcutis 5 or 6 cm. long 



f over the line of division between the two extensors of the 



' ■ foot. Superficially the operator passes near by the musculo- 



„■ -cutaneous division of the anterior tibial nerve, NMC, Plate 



] XXXII, which must not be mistaken for the deep branch. 

 ^ The peroneus muscle, MP, Plate XXXII, and P; Plate 

 XXXI, is separated from the extensor pedis longus, EP, 

 Plates XXXI and XXXII, by a strong sponeurotic sheath 

 continuous with the tibial aponeurosis. Penetrate the latter 

 anterior to the aponeurotic partition directly against the ex- 

 tensor pedis, EP, and passing along the posterior border of 

 this muscle to a depth of 2 to 4 cm., there appears the thin 

 margin of the flexor metatarsi magnus, FM, Plates XXXI 

 and XXXII, which lies immediately against the extensor 

 pedis without a visible connective tisstie partition but reveal- 

 ing itself by a markedly lighter shade of color and its ready 

 separation with the scalpel from the extensor. The deep 

 branch of the peroneal nerve, NP, Plates XXXI and XXXII, 

 lies loo.sely imbedded on the anterioir side of the margin of 

 the flexor metatarsi -facing the extensor pedis, at times 

 visible at the margin, at others placed more deeply reaching 

 in some cases a distance from the margin of 4 or 5 mm. 

 Within this range is seen the slender nerve trunk almost 

 devoid of surrounding connective tissue and measuring 

 about 2 mm. in diameter. Pass the aneurism needle beneath 

 it and remo' a piece 3 to 4 cm. long. Close the cutaneous 

 wound with interrupted sutures and dress antiseptically 

 without a bandage. 



