. Medical and surgical therapy. neigh-bouring nerve, or the peri-pheral end on to a neigh-bouring mixed nerve (). Grafting. —In all thosecases in whichthe intervalbetween two extremities of the nerves istoo wide to allow of direct suture, the twoends can be joined together by the inter-position or grafting of a segment of anothernerve. A small piece of a sensory nerve istaken and placed between the two endsof the cut nerve and sutured as before(fig- 28). The results of nerve grafting which apriori appears to be a logical procedure,cannot yet be appreciated, since regenera-tion is beset w
. Medical and surgical therapy. neigh-bouring nerve, or the peri-pheral end on to a neigh-bouring mixed nerve (). Grafting. —In all thosecases in whichthe intervalbetween two extremities of the nerves istoo wide to allow of direct suture, the twoends can be joined together by the inter-position or grafting of a segment of anothernerve. A small piece of a sensory nerve istaken and placed between the two endsof the cut nerve and sutured as before(fig- 28). The results of nerve grafting which apriori appears to be a logical procedure,cannot yet be appreciated, since regenera-tion is beset with difficulties and takes placebut slowh. WTiat happens to this nervesegment deprived of all blood-supply andused as a scaffold ? J. Sicard has suggestedneuro-vascular auto-graftinghy transplantingthe segment of a neighbouring nerve whilepreserving a large pedicle of vascular andconnective tissue. This procedure would be applicable in all cases P^ w Fio. 28.—Nerveg raf t.(After ) SURGICAL TREATMENT OF INJURIES 313. Fio. 29.—Lateralnotch treatedaccording toGossets method. where there was a healthy sensory nerve in the neigh-bourhood. Lateral Notch. Preserve the Continuity.—The lateralnotch should be treated according toGossets method. Preserve the bridgeof nervous tissue, pare away slightlyall the wall of the notch, and suturethe two lips end to end (fig. 29). Crushing, Pseudo-continuity, Resec-tion.—WTien the nerve is very com-minuted, much torn, crushed, adherentto the neighbouring fibrous tissue, orimprisoned within a callus (as veryfrequently occurs in lesions of themusculo-spiral nerve), it often appearsat the site of lesion as a flattenedfibrous band situated between twoswellings on the nerve and of a greaterlength than the nerve-trunk itselfshould be. These cases are nearly always ex-amples of complete section of the nerve with pseudo-continuity, the tissues between the two swellingsconsisting of fibrous and muscular tissue only. Underthese conditions
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