NEUROTOMY OF THE ULNAR NERVE. 



179 



Tamponade the wound with dry iodoform gauze and ap- 

 proximate the skin with a continuous suture. The tampon 

 and sutures remain 1 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 

 the lower part of the carpus, covered by the tendon of the 

 oblique flexor becomes the lateral plantar nerve, neurotomy 

 of the median nerve does not always completely effect the 

 desired end. In order to produce complete anaesthesia of 

 the foot, therefore, it is necessary to perform ulnar 

 neurotomy. 



39. NEUROTOMY OF THE ULNAR NERVE. 

 Plates XXIX-XXX. 



Object. An adjunct operation of the preceding by 

 which the enervation of the carpus and foot is completed. 



Instruments. Same as in the preceding. 



Technic. Above and behind the carpus there may be 

 felt a groove between its external and middle flexors, EF 

 and OF, Plate XXX. At this point 10 cm. above the 

 pisiform bone the skin is shaved and disinfected and an in- 

 cision 6 cm. long made through the skin and antibrachial 

 fascia. This incision extends just outside the median line 

 of the posterior surface of the radius in such a way that the 

 superior angle of the wound is about i cm. farther out- 

 ward than the lower. Beneath the fascia between the 

 aforesaid muscles is seen the ulnar nerve, Plate XXIX, n 

 Plate XXX, NU, on the median or inner side of it the 

 collateral ulnar vein, Plate XXIX v, and between the two 

 and somewhat deeper the collateral ulnar artery, a. The 

 nerve, about 3 mm. in diameter is picked up with the 

 aneurism needle, severed at the upper and lower angles of 

 the wound, the lips of the wound united by a continuous 

 suture and a bandage applied. Healing by first intention. 



