No. 3-] PERIPHERAL NERVES. 63 1 



{d) Union of ends with catgut threads, or a bundle of catgut 

 threads (suture a distance, Assaky). 



{e) Nerve flap from central stump, or a flap from both 

 central and peripheral stumps (autoplasie nerveuse a lambeaux, 

 Letievant). 



(/) Grafting of the central end of the peripheral stump of a 

 divided nerve to an accompanying nerve trunk (greffe nerveuse, 

 Letievant). 



{g) Cross-suturing the long central and peripheral stump, in 

 cases where two accompanying nerves are cut obliquely, and 

 grafting the central short stump to central long one, and 

 peripheral short stump to peripheral long one (Letievant, 

 Tillmanns). 



{Ji) Resecting the bone or bones in the extremity and sutur- 

 ing the nerve (Lobker). 



{a) Nerve StvetcJiing. — Schiiller does not mean to be under- 

 stood as advising actual stretching of a divided nerve, but 

 states that a nerve can be drawn out from the loose connective 

 tissue surrounding it, and then, by placing the extremity in a 

 position which relaxes the nerve, the separated ends can often 

 be brought together. The force should be applied to the 

 longer end. Kolliker estimates that a separation of 2 to 3 ctm. 

 may in this way be overcome. Schiiller has shown that, in 

 some instances at least, the ends may be brought together 

 after a separation of 4 to 5 ctm. He reports the case of a 

 man aged 19, who, nearly six months before Schiiller saw him, 

 had injured one of his median nerves under the annular liga- 

 ment. Sensation in the median area of the hand was lost, and 

 the muscles of the ball of the thumb had atrophied. After 

 exposing the nerve and vivifying the ends, they were 5 ctm. 

 apart. He was able to draw down the central end, and suture 

 it to the peripheral stump. The report records a return of 

 sensation in the part of the hand supplied by the median, and 

 also a return of function in the thumb muscles. 



Quite recently Von Hacker reports the case of a boy aged 9, 

 who, about three months before the nerve suture was made, 

 had fallen while carrying a glass pitcher, and had completely 

 divided the left median a little above the elbow. Soon after 



