NEURECTOMY OF THE MEDIAN AND OF THE ULNAR NERVES. 93 



inner surface of the limb is well uncovered, and by kneeling in front of 

 the chest, near the neck, the operator can proceed in comfort and entire 

 safety. 



[The operation of median neurectomy is as follows. 



The median nerve is readily discovered on the inner surface of the 

 forearm, running obliquely downwards and slightl}' backwards just 

 behind a ridge on the head of the radius, into which is inserted the 

 internal lateral ligament of the elbow. It crosses the posterior radial 

 artery at a very acute angle, and passes with it towards the posterior 

 surface of the radius. The posterior radial vein (or veins) is situated 

 in front of the nerve. The operation is performed opposite the lower 

 portion of the elbow-joint, or immediately behind the upper extremity 

 of the radius towards the upper point in the depression between the 

 radius and the flexor muscles of the fore-limb. 



The skin having been shaven and disinfected, an incision about an 

 inch in length is made, traversing successively the skin, subcutaneous 

 connective tissue, and the prolongation of the posterior superficial 

 pectoral muscle. Towards the lower angle of the wound the fascia of 

 the forearm is slightly incised, a grooved director passed under it and 

 pushed upwards, parallel with the nerve. By passing the bistour}- 

 along the groove the fascia is then laid open. Another method consists in 

 using a probe-pointed bistoury. Certain operators even go so far as to 

 snip away with scissors an elliptical fragment of fascia on either side, 

 thus more freely uncovering the nerve. The skin wound is then held 

 open with retractors. The next step in operation consists in dissecting 

 free the nerve (sometimes a rather tiresome process), and raising 

 the nerve on a grooved director or tenaculum. The nerve is cut 

 through as high up as possible, and again near the lower limit of the 

 wound, a piece about three quarters of an inch in length being removed. 

 The operation is concluded by wiping the wound dry, dusting with 

 iodoform, suturing the skin, and applying a little iodoform collodion or 

 similar dressing. — Jno. A. W. D.] 



When the incision is skilfully made at the proper point, and the 

 antibrachial aponeurosis opened, the nerve often appears immediately 

 as a flattened whitish cord, which has a tendency to become thrust 

 forward and to protrude between the lips of the incision in the apo- 

 neurosis. This occurred in our horse. The operation only lasted a few 

 minutes. When the nerve does not appear, it is usually sufficient to 

 slightly alter the position of the limb in order to bring it under the 



