Median neurotomy 



173 



Only the skin is divided at this time. The underlying 

 areolar tissue may then be picked up here and there and cut 

 away in search of one or more rather prominent veins which 

 cross the field. When these appear upon the foreground 

 they are twisted with the forceps to avoid a masking but 

 trivial bleeding. 



The subjacent muscle now exposed is divided from one 

 commissure of the skin incision to the other by a number of 

 cautiously directed strokes of the scalpel. As this incision 

 proceeds the dissecting forcep in the left hand is used to 

 separate the divided muscle in search of the underlying thick 

 fascia which bounds the muscle internally. This fascia must 



Fig. 



100 — Position of Incision in Median Neurotomy, showing Median 

 Nerve and Flexor Branch. End of fourth step (Bayer). 



be brought into clear view without accidentally wounding it, 

 and all bleeding must be controlled, before proceeding 

 farther. 



The fascia (the antibrachial) is a very thick, whitish, 

 tough membrane at this point. It lies in close relation to the 

 median nerve, the radial vein and the posterior radial artery. 

 The greatest danger of median neurotomy lies in the im- 

 proper division of this structure. If incised with a scalpel the 

 radial vein may be wounded in spite of the greatest caution. 

 To avoid this very serious accident the fascia is divided with 

 the probe-pointed bistoury, cutting upward and outward 

 after making a very small point of entrance with the tip of 

 the scalpel. 



