The broad ax., 1899-07-29

In a certain proportion Of cases Of
injuries to nerves the ends cannot be
brought together and a portion of
nerve obtained from one of the lower
animals or from an amputated limb
has been implanted. DR.. r. Peterson
contributed an important article on
sransplantation of nerves to the Amer
lean Journal Of the Medical Sciences
which contains an original case and an
analysis Of the small number OF pre-
viously recorded cases. A man, aged
"a. was severely injured in the right
wrist by q circular saw. The ulnar ar
terry and fiepor tendons were severed.
The latter were Immediately sutured.
He lost sensibility in the hand and lat
er there were trophic changes-glossy
skin, corrugated nails and liberation
OF the skin, and marked atrophy OF the
small muscles. Five months after the
injury the divided ends Of the median
nerve were exposed. They were found
to be united by connective tissue. The
proximal end formed a hard bulb. The
removed, leaving gap. So much force
was required to bring together the cut
ends that transportation of nerve was
decided upon. Four centimetres of the
sciatic nerve of a young black hound
were sutured between the ends with a
kangaroo tendon. A similar operation
was performed on the ulnar nerve. On
the following day distinct return OF
sensibility in the thumb was found;
the fingers could not be tested without
disturbing the bandage. Two months
after the operation the skin had lost
its shiny look and appeared normal
and the muscles, though still atrophied.
were regaining power. A month later
sensibility was complete except on the
dorsal surface Of the third phalanges
of the second, third and fourth fingers.
The only anaesthetic areas on the pal
mar aspect were on the second and
third phalanges Of the third and fourth
fingers and on the third phalanx OF the
second finger. There are twenty re-
corded cases of transportation OF
nerves. The median nerve was operat-
ed on in seven cases, the ulnar in three,
the median and ulnar nerves in two,
the musculo-spiral nerve in seven, and
the sciatic in one. There were eight
primary and twelve secondary opera
tions. The time from the injury to
the operation varied from f6rty-eight
hours to one and a quarter years
Eight out OF the twelve cases OF sec
ondary operation showed improvement
in sensibility or motion, while only
four out of the eight cases of primary
operation improved. The interval be-
tween the ends Of the divided nerves
varied from three to ten centimetres,
but distance did not seem to affect the
result. In nine cases the transplanted
segments were from the sciatic nerves
of dogs, in three from rabbits, in one
from a kitten, in one from the spinal
cord OF rabbit, and in five from re-
Gently amputated limbs. In one case
an inch Of the seiatic nerve which had
been excised was itself transplanted.
In nine cases catgut was used to unite
the implanted segments to the divided
ends, in three silk, and in one kanga-
roo tendon. No case recovered entire
ly. The nearest approach to complete
recovery took 'place in the case long
est under observation, in which at the
end Of six years sensibility had entire
ly returned and the only weak muscle
was the abductor pollicis. In three
cases there was practical recovery of
sensibility and motion and the hand
was useful. Sensibility completely re-
turned in four cases, nearly completely
in three cases, and was improved in
four cases. There was improvement
in either motion or sensibility in
twelve cases. and no improvement in
either in six cases. The average time
in which sensibility appeared after the
operation was about ten days; motion
returned in about two and a half
months.
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