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

242 INJURIES OF NERVES.
cases left in the nerves of clogs metallic sutures which
were never removed, but which apparently gave not the
slightest annoyance after the nerves had reunited. M.
Vulpian* regards neural suture as harmless, and thinks
that the opposite opinion held by Eulenberg and Londois
must have been due to their use of the rabbit onl}',
an
animal which bears badly
all nerve lesions.
The evidence in favor of reg-arding nerve suture as not
when we unite the clinical
injurious, is therefore ample
and physiological statements, both of which seem to
decide very conclusively that after its
employment the
time needed for healing is notably lessened. The case of
Verneuil, already alluded to, is further cited by Tillaux
and Paulet to support this view. Both ulnar and median
had been severed, but the suture was used in the latter
alone, with the result of rapid
return of sensation for
parts fed by the median, and very slow sensor^" restoration
of the ulnar territories,
— exactly the result which has
attended the phj'siological use of the suture. There
seems, therefore, to be justification for the employment
of sutures in any nerve wound, and especially where
there has been loss of substance, as after removal of a
neuroma.
The mode of using the suture is important. Nelaton
found it difficult in his first case to remove the threads.
In his second case he passed a thin silver wire through
the ends of the nerve within three millimetres of the cut
the faces of the section
surface, so that being drawn upon,
would meet and not ride over one another, as they might
liave done had he followed Laugier in passing his thread
remote from the cut. The ligature drawn through one end
of the nerve returns through the other, and the two ends
were imprisoned in a long tube of Galli, which reposed
* Tillaux, p. 96.