Transplantation of a peripheral nerve segment to bridge over a gap between the two ends of a resected nerve is a legititnate surgical procedure. Under fa vorable conditions at least partial, and at times complete, restoration of sensation and motion may be expected to follow the operation. Regeneration of the de generated peripheral end is due to down growths front the axis-cylinders of the central end. From the slowness of this process the longer the time after opera tion, the more favorable will be the re sults. Sensation may return very early after operation, and, as a rule, precedes return of motion. This rapid return of sensation is not due to down-growth of axis-cylinders or to conductivity of the transplanted fragment, but mnst be ex plained by collateral nen-e-supply. In Symptoms.—The clinical signs vary greatly with the nature of the injury, thE more acute symptoms often attending slight lesions, while complete de.,,truction may not give rise to suffering. A slight blow mav, for instance, momentarily suspend the conductive power, occasion quite severe pain at the seat of the in jury, local heat and tingling at the pe ripheral ending of the nerve struck, while destructive crushing may lie attended by no pain whatever, but with loss of sensa tion and of mnscular power, followed by wasting. At times neuritis follows. with paralysis as an occasional consequence. complicated with disorders of nutri tion of the cutaneous tissue, nails, etc.
The continuity of the nerve being pre served, the chances of recovery are much greater than after section, though occa sionally, especially when some of the branches of the. brachial plexus are bruised during falls upon the shoulder, permanent paralysis of the portion of the arm supplied by the nerve ensues. In other regions of the body, however, great injury alone will give rise to such serious sequelee. Severe neuritis with pain in tbe parts to which the nerve is distrib uted and trophic disturbances are occa sionally observed.
Diagnosis.—The extent of damage to wasting of the region occurs, the likeli hood that the nerve is torn apart by crushing is proportionately great.
Treatment.—The treatment depends upon the extent of the injury. If the latter is not severe and the faradic— though reduced —excitability persist, thorough rest of the part, splints being used for the extremities and retention bandages for the trunk, will he followed by prompt recovery. The treatment of the bruised tissues surrounding the nerves will answer all purposes. If pain be present, morphine injected hypoder mically in the nearest uninjured tissues the nervous supply of a contused region may usually be determined with the aid of electricity. If tbe muscle reacts nor mally to the faradic current, applied sev eral times at intervals of about two hours, the injury is ni/ or slight. If, on the con trary, the reaction shows a tendency to become less marked or to disappear, the injury is severe, though not necessarily, destructive; if it is completely inter rupted or the region supplied by it gives the reaction of degeneration, the prob ability is that the continuity of the nerve has been interrupted; if, in addition, may be employed. The addition of
grain of atropine in the CaSe of an adult greatly enhances the anodyne effect of the opiate. If the injury he severe and the electrical indications that the nerve has been torn are present, the treatment becomes that of incised wounds (q v .), but in subcutaneous injuries the likeli hood that the nerve-ends are far apart is slight and the chances of a reunion is increased in proportion. An important feature of these cases, however, is that the contusion usnally involves the sur rounding tissues and especially their vas The ‘itality of the parts is Tondingly reduced. Warmth, cal ( ulatiAl to facilitate the local circulation mud nutrition, should therefore be sus tam«1 bv suitable covering: cotton-wool alai. if need be, hot-water or hot-sand bag,.
As S0011 Z16 tile inflammatory stage has pa-sL (1. means calculated to enhance local nutrition should be resorted to. .:1Iassage, frktions, and galvanism are the most active means at our disposal. Oalvanism is more effective than faradisin. Daily sittings of ten minutes each are suffi cient, a weal: current being employed. The parts should be thoroughly wetted to insure penetrati6n.
Compression.
Comprk.,ssion, as here understood, ap plies to that resulting feom the pressure of a tumor, an aneurism, scar-tissue, callus, etc., or an external agent such as an encysted bullet, a splinter, etc., or from pressure between a neighboring bone and an external object, as occurs frequently in persons using crutches, or when both arms are held under the bead during sleep. Dislocations, especially those of the head of the humerus, often give rise to compression, while the heel of a careless surgeon's shoe when forced into the axilla during the process of re duction occasionally adds to the dangers of the occasion. Fractures of the hu merus are often attended by lesions of the musculo-spiral, while fractures of the clavicle are frequently accompanied by pressure and laceration of some of the branches of the brachial plexus. In ob stetrical practice the child's head is some-. times so compressed by forceps as to con duce to palsy of the seventh pair.
The symptoms and diagnostic features do not differ from those described under contusion.
Treatment.—The condition acting as cause must first of all be removed if pos sible. When an extremity is the scat of trouble, this can usually be accomplished, even aneurisms being subject to cure. When a decp-seated nerve of the trunk is compressed, however, the difficulties are greatly increased and a satisfactory operation cannot always be resorted to. After removal of the cause the aim should be to encourage nutrition of the area of distribution by arsenic or strychnine, along with the electrical treatment rec ommended above under CONTUSION.