MODERN NEUROTOMY. 
209 
The technique of the low operation .—Immediately below the 
metacarpo-phalangeal articulation, a surgical triangle is formed, 
its base, reversed, is represerted by the lower part of the articu¬ 
lation, and being shorter than the other two legs renders the 
triangle isosceles, the anterior leg is formed by the posterior ex¬ 
ternal or internal border of the first phalanx, while the posterior 
leg is formed by the anterior edge of the perforans tendon. 
Within this triangular space (which is well marked in a clean 
limbed short-haired horse) are contained the vessels and nerve 
of the lower part of the digit; their position, running from before 
to behind, may be recollected by the unremonic word VAN— 
vein, artery, nerve. They are crossed superfically, and somewhat 
obliquely by the tendon of the ergot; this tendon varies in shape, 
sometimes it much resembles in appearance and calibre the nerve 
of the part, again it may be double, or may form a somewhat 
broad and considerable sheet, whose division may be necessary 
in order to reach the underlying nerve. 
A bisection of this triangle on the line of its long limbs al¬ 
lows the nerve to be readily reached. When exposed it should 
be stretched until an inch can be readily removed from a cuta¬ 
neous incision of about half that length. Nerve stretching is 
an important part of the procedure, as it allows the cut end to 
retract beyond reach of the cicatricial tissue, and thus avoids the 
danger of subsequent neuroma, and as the nerve is much more 
extensible than the artery, it allows differentiation in case the 
operator’s eye for form and color is not good, or in cases where 
the slight haemorrhage obstructs the view. It is not necessary 
to expose much of the nerve before passing the needle under it,, 
and I often isolate it by passing the point of the needle beneath 
it, then using the needle as a lever, with the first phalanx for a 
fulcrum, draw the nerve from its bed. We must look for heal¬ 
ing by first intention, and remember that every torn shred of 
tissue lessens the chances of our gaining that end. When the 
nerve is sufficiently stretched it should be held taut outside of 
the incision, the distal end removed at the lower commissure so 
as to leave for healing but a clean skin wound. 
