NEUROTOMY OF THE MEDIAN NERVE. 165 



of the nerve, and the fascia is divided with the scalpel and 

 an oval piece excised with the scissors immediately over it. 

 If much fatty tissue is found beneath the fascia it may be 

 dissected away carefully with the scalpel or cut away with 

 the scissors. There now comes into view a delicate reddish 

 colored fascia-like membrane, the nerve sheath, behind 

 which a blue cord, the brachial vein, V, is visible, the latter 

 being intimately connected with the nerve sheath. The 

 vein lies mostly behind and beneath the nerve and may pro- 

 ject out from beneath the border of the same. The opera- 

 tor needs be careful not to prick this vein with the tenacula, 

 as the hemorrhage, therefrom is exceedingly annoying dur- 

 ing the operation. It is best to avoid the use of tenacula 

 after penetrating the fascia and retract the wound lips 

 cautiously with aneurism needles instead. Still further 

 forward and deeper may be felt the pulsating brachial 

 artery-.- Incise th e nerve sheaj:h^arefully_and diyide it up- 

 war d an d downward with the scalpel or scissors, whereupon 

 the yellowish and distinctly fibrous nerve comes into plain 

 view. Pass an aneurismueedle benea,tli_the nerve then pass 

 another alongside the first and drawing the two apart sepa- 

 rate the nerve from the adjacent tissues throughout the 

 length of the wound. Be careful to not cut 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. 

 I^ift 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. Tamponade the wound with dry iodoform 

 gauze and approximate the skin with a continuous suture. 

 The tampon and sutures remain from i to 2 days. 



Since sensation of the lower part of the hmb is partly 

 maintained by the deep branch of the ulnar nerve which at 



