The _Open operations_ may be placed under two separate headings—one in which the bands are merely divided in one or two places, and the other in which the morbid tissue is excised as far as possible. The first of these, however—the original method of Goyrand—may now be held as superseded, since it has neither the safety of the subcutaneous method nor the thoroughness of the more radical measure. We need therefore only discuss the latter. The cutaneous incision may be either longitudinal and linear, as practised by Goyrand, Kocher, and others, or V- or Y-shaped, after the method of Busch, Madelung, and Richer. In any case the reflected skin should be very gently dealt with, and the wound carefully closed after the removal of the diseased bands. In most instances the simple linear incision gives all that is required, but the other varieties are useful when the distal end of the band branches or expands. The isosceles flap of Busch is made with the base opposite the metacarpo-phalangeal joint, the apex at the distal extremity of the hollow of the palm. (Fig. 4.) When the hand is extended after section or excision of the contracted tissue the apex of the flap is drawn away from the angle of the incision, and the wound when closed assumes a Y-shape. A Y-incision, with the fork over the first phalanx, and the stem corresponding to the palmar cord, is of advantage where the fibrous band spreads out broadly and becomes adherent to the skin beyond the metacarpo-phalangeal joint, the reflection of the angular flap within the fork allowing the safe removal of the diseased tissue. In any of these operations the anatomical relations of the vessels and nerves should be carefully borne in mind. Fortunately the morbid tissue seldom encroaches upon the nerve tracts in such a way as to expose them to danger. The best rule for the surgeon is to confine his dissection as far as possible to the tissue overlying the axes of the flexor tendons, and not to make any further lateral excursion than is absolutely necessary. Extreme care, however, will always be needed in excising cords which run towards the inter-digital web, as these lie directly over the nerves. The tendons are quite safe in the palmar incisions, as they lie much deeper than the fibrous cords, but the diseased tissue is closely related to the thecæ in the fingers. The after-treatment is similar to that recommended for the subcutaneous operation, but for obvious reasons the necessity for antiseptic precautions is more vital in the open method. No drainage is required. [Illustration: FIG. 4. DIAGRAM SHOWING INCISIONS FOR OPEN AND SMALLER PLASTIC OPERATIONS. 1. Straight incision (Goyrand); 2. Y-incision modified to allow incision of digital expansion of band; 3. V-incision of Busch; 4. Position of flap to fill gap left by section of contracted band and superjacent integument (Author’s method).]