TENDON-TRANSPLANTATION. — In the treatment of paralysis, especially spinal paralysis in children, transplantation of tendons is an effective procedure. E. Kumik (Miinchener med. WTochen., Feb. 12, 1901) describes four operative methods: The first he considers inad visable, since it necessitates the sacri fice of a functionally-healthy muscle. It consists in choosing a healthy muscle which can be spared, dividing its ten don, and suturing the central portion to the tendon of the paralyzed muscle. I The second operation, Vulpius's, con sists in dividing the whole or a part of the tendon of the paralyzed muscle, and suturing the peripheral end to the ten don of a functionally-active muscle. The third variation consists of splitting } the tendon of a functionally-healthy muscle into two parts, and attaching one part to the tendon of the paralyzed muscle. The fourth proceeding, of which he has only availed himself once, and which is said to give very accurate and good results, is the suturing of a split-off portion of a healthy muscle tendon to a properly-chosen site in the periost cum.
The success of the operation depends partly on the correction of the displace ment, and this is better carried out by a lengthening or shortening of tendons than by simple teuotomy. Kumik uses Beyer's (really Poncet's, see page 139) operation for the former, which consists in cutting into the tendon in step shape, or, in dealing with broad tendons, he makes two longitudinal incisions of equal length, one 1 centimetre higher than the other. From the lower end of the second, and from the upper end of the first, transverse incisions are made in opposite directions. Thus, the
tendon is lengthened by the sum of the two incision lengths. The shortening operations are either excision of a part of the tendon and end-to-end suture, or simple division and suturing the ends overlapping one another. Tendon surgery has been greatly advanced by a skilled combination of tendon-trans plantation with tendon- lengthening or shortening.
The operations can be performed for the functional improvement of cases of paralytic talipes equino-varus, spastic talipes equino-valgus, congenital talipes equino-varus, radial paralysis, and quadriceps extensor cruris paralysis.
The results are very satisfactory, and from the patients' and patients' parents' view especially, because splints and ex pensive cumbrous apparatus were no longer required.
The surgeon ought to propose the operation, when the paralysis is no longer active, and when no functional improvement has shown itself during the course of a reasonable time: for ex ample. one to two years. Operative in terference is, however, always indicated if the resulting deformity is increasing. But an exact diagnosis is necessary be fore undertaking an operation; it is ab solutely essential to be fully informed as to the electrical and other conditions of each individual muscle of the limb. After the operation is performed, a splint of plaster of Paris, kept in place by means of strips of gum-elastic strap ping, is applied. From six to eight weeks' massage, active and passive movements, are resorted to.