MEDIAN NEUROTOMY 



175 



Sixth Step. — The Neurotomy.— This step is simple, and 

 now without danger. It is performed, as all other neurot- 

 omies, by first dividing the nerve superiorly and then in- 

 teriorly. 



Seventh Step.— Closing the Wound.— The wound of 

 median neurotomy never heals by primary union. If the 

 fascia, the muscle and then the skin are consecutively 

 sutured with the greatest caution, the wound will burst open 

 in spite of everything, in spite of every precaution, because 

 the, relations of these structures and the several parts of each 

 of them, change considerably from the recumbent to the 

 standing position. A wound sutured neatly in the recum- 

 bent position will always be found distorted when the stand- 



Fig. 101— Fifth Step of Median Neurotomy. The Nerve Elevated. 



ing posture is attained. The irregular tension of the sutures 

 on the different parts of the wound precludes prompt union. 

 With this fact in view it is found advisable to close the 

 wound with only one or two loose stitches, leaving the 

 breach to heal by secondary intention. 



AFTER-CARE.— The patient is kept quiet in the stand- 

 ing position for two or three days and then turned into the 

 loose box during the remainder of the convalescence. The 

 wound requires no special attention if the operation has 

 been clean. The only medical treatment required is a nom- 

 inal washing of the internal surface of the forearm to rid it 

 of the little secretion- that flows over it from the wound dur- 

 ing the first week. The wound itself needs no irrigation nor 



