890 



MEDIAN NEURECTOMY. 



well forward and an incision about an inch and a half in length is 

 made, traversing successively the skin, subcutaneous connective 

 tissue, and the prolongation of the superficial pectoral muscle. Any 

 bleeding vessels are carefully closed with Wells' forceps, and the seat 

 of operation is cleared of blood. The operator then assures himself 

 by palpation that the nerve lies in or near the middle of the incision. 

 Should this not be the case, the limb is moved slightly forwards or 

 backwards until the nerve is brought into the desired position. 

 Towards the lower angle of the wound the fascia of the fore-arm is 

 slightly incised, a grooved director passed under it and pushed upwards, 

 parallel with the nerve. By passing the bistoury along the groove 

 the fascia is then laid open. Another method consists in using a 



Fig. 506. — Median neurectomy (semi-diagrammatic). N, Median nerve ; A, posterior 

 radial artery ; V, one of the post-radial veins. 



probe-pointed bistoury. Certain operators even snip away with 

 scissors an elliptical piece of fascia on either side, thus more fully 

 exposing the nerve. The skin wound is then held open with 

 retractors. The next step consists in dissecting free the nerve, 

 which is often surrounded with fibro-fatty tissues, and raising it on 

 the 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 an inch in length being removed. The operation is concluded 

 by disinfecting the wound, dusting with iodoform, suturing the skin 

 and applying a little iodoform collodion or similar dressing. 



When the incision is made at the proper point, and the anti- 

 brachial aponeurosis opened, the nerve often appears immediately 

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



