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

284 INJURIES or nerves.
but unless there should be at the same time some return
of the normal function of the divided trunk,
it is more in
accordance with the observed facts to believe that renewed
pain, after section or exsection, is most often due to the
presence or to the gradual increase in the central end of
a nerve of the same disease which necessitated an operation.
In other words, the section should have been made
higher up the nerve.
Where the neuralgic cause is purel}- local, and the
trunk unaltered by sequent changes, the operation ought
of course to be done at the lowest point possible, and will
then ofier the best chance of success.
The operative procedure must vary with the nerve,
but there are certain indications to be fulfilled in every
instance. If, when the nerve has been fully exposed,
it
should prove to be hard, red, and congested, the track
sliould be followed upward, or a new incision made above,
until a healthy point has been found.
Simple division of the nerve is at present scarcely ever
practiced. [N'ot less than two inches of its length ought
to be removed, our object being to make reunion impossible,
or at least very remote in point of time. It has been
advised to cauterize the cut ends, but a more sensible plan
is that of Malgaigne, who counsels us to double the' nerve
ends on themselves,
— a measure which I should think
very unwise as regards the central end, while I see no
reason whj' the peripheral extremity should not be thus
reverted, and, if necessary, secured by a removable loop
of silver wire.
With this precaution, reunion would be out of the question,
but assurance may be made doubly sure by further
following the French surgeon's advice, and interposing a
piece of muscle or fascia.
Such precautions are not vain, since even where two
inches of nerve have been cut out, function has returned,