148 ULNAR NEURECTOMY 



whereupou the yellowish and distinctly striated nerve comes 

 into plain view. Pass an aneurism needle beneath the 

 nerve, pushing it so far through that the distal end is readily 

 grasped and drawing it up and down with the two hands, 

 separate the nerve from the adjacent tissues throughout the 

 length of the wound. Be careful not to ad the nerve too high 

 and erroneously include the motor nerve of the flexor of the 

 metacarpus and the flexors of the foot, which is generally 

 given off posteriorly 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 bistoury. Lay the peripheral end of the 

 nerve bare to the lower angle of the wound, and excise at 

 least 3 cm. of it. Disinfect the wound and approximate the 

 skin with a continuous suture. The tampon and sutures 

 remain 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 

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

 oblique flexor, becomes the lateral plantar nerve, neurectomy 

 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 

 neurectomv also. 



43. ULNAR NEURECTOMT 

 Figs. 55 , 56 



Object. An adjunct operation of the preceding by which 

 the enervation of the carpus and foot is complete^, 



Instruments. Same as the preceding. 



Technic. Above and behind the carpus there may be 

 felt a groove between its external and middle flexors, EF 

 and OF, Fig. 55. At this point, 10 cm. above the pisiform 



r, ■' ■ 



