544 
INJURIES TO THE KNEE IN THE HORSE. 
the fore arm and drawn forcibly backwards; the knee is thus fully 
extended. An Esmarch bandage is applied above the knee, to control 
bleeding at a later stage. 
The limb is clipped, the seat of operation and a liberal space on either 
side (about twelve inches above and below the scar) are shaved, a 
lozenge-shaped area corresponding to the part to be excised being left, 
however, so as to guide the operator at a later stage. The parts are 
then rinsed carefully with permanganate of potash solution, followed by 
bisulphite of soda solution, which removes the discoloration caused by 
the permanganate. (A variation of this method may be made by sub¬ 
stituting for the permanganate and bisulphite solutions, boiled water, 
tinged a deep sherry colour by the addition of iodine tincture.) Finally 
the parts are washed with ether, and immediately covered with pieces of 
linen removed from boiling water. 
In the meantime the operator and his assistant have thoroughly 
cleansed their hands, arms, and finger-nails in a similar way, and with 
similar solutions. The operation, properly so called, then begins. 
2. The importance of the unshaven area now becomes apparent. 
Being symmetrical, the edges of the wound traced round it will afterwards 
exactly coincide, forming a straight line. It is advantageous to trace 
this area in a line inclined obliquely to the long axis of the limb. The 
final linear cicatrix is then extremely difficult to discover. In this way 
it is possible to remove scars as large as a five-shilling piece, leaving a 
very trifling cicatrix. Scars of a larger size may be greatly diminished, 
though not entirely removed. 
The operator makes the first incision without stoppage, as it is 
extremely important to produce clean-cut edges; the scalpel should 
penetrate the entire thickness of the scar, stopping just short of the 
synovial sacs. The second incision is made in a similar manner. He 
then carefully dissects away the flap from the underlying tissues, 
removing at the same time as much of the thickened (cicatricial) 
material as possible, but taking great care not to open the synovial sacs. 
This operation finished, the remaining fibrous tissue must be removed, 
so as leave the base of the wound perfectly level, and any trifling 
haemorrhage checked by picking up and ligaturing bleeding vessels. If 
the piece of tissue thus removed is so broad as to render it difficult to 
bring together the edges of the wound, the skin may be dissected from 
subjacent tissues over the entire front of the knee and two lateral skin 
incisions made (figs. 198 and 199). It will then glide easily, and offer 
much less resistance to the coaptation of the wound edges. 
3. When bleeding has ceased the surface of the wound is carefully 
dried with pledgets of aseptic or carbolised gauze, care being taken to 
avoid the formation of blood-clots, which check healing. In a few 
