. Minor and operative surgery, including bandaging . the metatarsal bones,where they are quite prominent. They may also bedivided near the ankle. The Extensor Proprius Pollicis.—This tendon may bedivided in the same incision used for division of the long 570 OPERATIONS UPON TENDONS. extensor of the toes, the point of the knife being carriedinward. The Sterno-cleido-mastoid Muscle.—In tenotomy of thismuscle, the sternal and clavicular attachments are dividedabout an inch above the sternum and clavicle. A punctureis made to the outer side of the muscle with a sharp teno-tome, and when the tendin
. Minor and operative surgery, including bandaging . the metatarsal bones,where they are quite prominent. They may also bedivided near the ankle. The Extensor Proprius Pollicis.—This tendon may bedivided in the same incision used for division of the long 570 OPERATIONS UPON TENDONS. extensor of the toes, the point of the knife being carriedinward. The Sterno-cleido-mastoid Muscle.—In tenotomy of thismuscle, the sternal and clavicular attachments are dividedabout an inch above the sternum and clavicle. A punctureis made to the outer side of the muscle with a sharp teno-tome, and when the tendinous expansion of the muscle isreached it is withdrawn, a blunt tenotome substituted, andthe structure divided (Fig. 480). The sternal attachment is inlike manner divided through a separate puncture. The exter-nal jugular vein at the outer border of the muscle is to beavoided. The division of the muscle, or its tendinousexpansion by an open operation, is now often practised, asthere is less risk of injuring the vein by this procedure. Fig. Tenotomy of sterno-mastoid. Suture of Tendons.—In bringing together the dividedends of tendons, primary or secondary sutures are em-ployed ; primary sutures are those introduced immediatelyafter the injury, and secondary sutures are those intro-duced after retraction of the ends has occurred and thewound has healed. Primary Suture of Tendons.—The material employed for SUTURE OF TENDONS. 571 sutures may be silk, silkworm-gut, catgut, or kangaroo-tendon, and one or more sutures should be used, beingpassed through the substance of the ends of the tendonand secured by tying; the divided sheath of the tendon,if possible, should be brought together by fine silk sutures(Fig. 481). Very marked retraction of the ends of thetendon is liable to occur, and a considerable dissection isoften required to bring them into view. Fig. 481.
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