Injuries of nerves and their consequences - Reflex Sympathetic ...

TREATMENT. 235
Sutures in nerve wounds.— Where it is plain, from a careful
study of the wound and the loss of function, that the
nerve trunk has been altogether divided, the surgeon
is
called upon to decide whether he will leave repair to
nature alone, or enlarge the wound and secure coaptation
of the nerve ends by the use of sutures. The propriety
of this step rests upon the manner in which we answer
these two questions: Will anj^ even the most perfect,
approximation
and, failing this, will it
of nerve ends insure immediate union ?
make likely a more speedy return
of health}' function ? To the first, we may give a certain
negative; to the second, we may, with some confidence,
reply in the affirmative.
As I have already pointed out, all the physiological evidence
is against the possibility of immediate useful union.
Within a few days the peripheral end of the nerve surely
degenerates, and in adult animals many months may pass
before it is restored and the two ends reunited. Even in
young animals the earliest re- establishment of function,
when the ends were made to touch by suture, was seven
or ten days (Schiff),
and nine days (Magnien). Vulpian
has no case within seventeen daj^s; and I have never met
with an instance even in so short a time as this. The physiological
facts are therefore opposed to the probability of
immediate union; but, on the other hand, we are met by
the statement that these were derived from lower animal
life alone, and that in man the rule as to the time demanded
for restoration may meet with exceptions, and
this possibility is supported bj certain clinical histories
which may not be altogether set aside.
In 1863, Paget reported two cases of nerve section in
children, aged respectively eleven and fourteen years.
The first had the median and radial nerves divided by a
clean cut from a circular saw. The wrist was placed in
flexion on the forearm, and after ten or twelve days there