. Manual of operative surgery. rs, thus dissociating the movement of dorsal flexion of the wrist anddorsal flexion of the I2l8 TENDON SHEATHS AND TENORRHAPHY Step I.—Make a three inch incision in the middle of the radial side of theforearm along a line joining the styloid process of the radius and the externalcondyle of the humerus. Through this cut expose the posterior border of thesupinator longus and retract this muscle forwards { ventrally). Recognizeand retract dorsally the tendons of the extensor carpi-radialis longior and brev-ior, thus exposing the broad tendon of the pr
. Manual of operative surgery. rs, thus dissociating the movement of dorsal flexion of the wrist anddorsal flexion of the I2l8 TENDON SHEATHS AND TENORRHAPHY Step I.—Make a three inch incision in the middle of the radial side of theforearm along a line joining the styloid process of the radius and the externalcondyle of the humerus. Through this cut expose the posterior border of thesupinator longus and retract this muscle forwards { ventrally). Recognizeand retract dorsally the tendons of the extensor carpi-radialis longior and brev-ior, thus exposing the broad tendon of the pronator radii teres the sharp dis-tinct upper edge of which is easily palpated. If the assistant pronates andsupinates the forearm, recognition of the muscle is facilitated. Step 2.—From the upper half of the tendon of the pronator make a flapwith pedicle above (Figs. 1556 and 1557). Pass the flap through splits madein the tendons of the two radial extensors and fix it to these tendons by afew fine sutures. Close the Fig. 1556. Fig. 1557. Fig. 1558. Step 3.—Make a four-inch incision parallel and internal (medial) to theradial artery beginning near the anterior surface of the styloid process of theradius and passing obliquely upwards and medially (Fig. 1558). Expose andfree the tendon of the palmaris longus and divide it as low as possible. Step 4.—Make an incision from the pisiform bone upwards for 2 3-^ inches(Fig. 1558) and expose the tendon of the flexor carpi-ulnaris. Free the tendonand divide it at its carpal insertion. This step is diflScult as the tendon isshort and receives muscle fibres almost to its insertion. Protect the woundsand mobilized tendons. Step 5.—Expose the extensor tendons of the fingers by a dorsal medianlongitudinal incision just above the wrist. Some surgeons use a horse-shoeincision and flap but this is unnecessary. With forceps make a subcutaneoustunnel from the dorsal wound around the radial side of the arm to the woundexposing the
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