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

TREATMENT.
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243
in the wound on the nerve, or very close to it, and projected
from the wound so as to allow the operator to fasten
his wires b}- bending them hooklike over the edges of the
tube. In disengaging the loops, it was only necessary to
lift the tube from the wound, and, releasing one end of the
wire, to draw upon it gently.
Vulpian uses in animals a single linen thread, which he
carries with a tine needle from the upper side of the nerve
obliquely through it,
so as to come out about the middle
It is then passed through the middle
of the cut surface.
of the exposed face of the opposite section and out at its
upper side, so that when the loop is made and drawn, it
brings the ends in exact apposition if the needle has been
made to penetrate precisely corresponding points of the
two faces.*
I myself used in animals, some years ago, a ditferent
method.
In place of transfixing the nerve, I carried the
needle through the loose tissue, which is related to its
sheath, sometimes using one thread, and at
other times
two, one being placed on either side. By drawing the
loops with care, it was possible to bring the nerve ends
into close relation. With rabbits it does not answer,
because of the small amount of areolar tissue about their
nerve trunks.
When, by suture and position, or other means, we have
placed a nerve wound of any kind in the most favorable
condition for healing, we shall find that no matter how
well exceptional cases may do, we shall usually have to
treat defects of motilitj' and mobility, altered states of
sensibility, and sometimes nutritive changes.
* For all that refers to nerve suture I am largely indebted to Tillaux.