NEUROTOMY OF THE MEDIAN NERVE. 143 



of the nerve, and the fascia is divided with the scalpel and 

 an oval piece excised with the scissors immediately over it. 

 If much fatty tissue is found between the layers of fascia it 

 may be dissected away carefully with the scalpel or cut away 

 with the scissors. There now comes to view a delicate red- 

 dish colored fascia-like membrane, the nerve sheath, behind 

 which a blue cord, the brachial vein, V, is visible, the latter 

 being intimately connected with the nerve sheath. The 

 ve'n lies mostly behind and beneath the nerve and may pro- 

 ject out from beneath the anterior border of the same. The 

 operator needs be careful not to prick this vein with the 

 tenacula, as the hemorrhage therefrom is exceedingly annoy- 

 ing during the operation. It is best to avoid the use of 

 tenacula after penetrating the fascia and retract the wound 

 lips cautiously with the aneurism needles instead. Still 

 further forward and deeper may be felt the pulsating brachial 

 artery. Incise the nerve sheath carefully and divide it upward 

 and downward with the scalpel or scissors, whereupon the 

 yellowish and distinctly fibrous nerve comes into plain view. 

 Pass an aneurism needle beneath the nerve then pass another 

 alongside the first and drawing the two apart separate the 

 nerve from the adjacent tissues throughout the length of the 

 wound. Be careful to not cut the nerve too high and errone- 

 ously include the motor nerve of -the flexor of the metacarpus 

 and the flexors of the foot, which are generally given off pos- 

 teriorly just below the humero radial articulation. Lift the 

 nerve up and cut it through at the superior angle of the 

 wound by a sudden clip with the scissors or with the probe 

 pointed scalpel. Lay the peripheral end of the nerve bare 

 to the lower angle of the wound, and excise at least 3 cm. 

 of it. Tamponade the wound with dry iodoform gauze and 

 approximate the skin with a continuous suture. The tampon 

 and sutures remain from i to 2 days. 



Since sensation of the lower part of the limb is partly 

 maintained by the deep branch of the ulnar nerve which at 



