Nerve-suturing (neurorrhaphy) : degeneration and regeneration following section : microscopical appearances : one of the Mütter course of lectures delivered before the Philadelphia College of Physicians / by De Forest Willard.

  • Willard, De Forest, 1846-1910.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Nerve-suturing (neurorrhaphy) : degeneration and regeneration following section : microscopical appearances : one of the Mütter course of lectures delivered before the Philadelphia College of Physicians / by De Forest Willard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    to give the procedures a fair trial, and to observe the microscopical changes, I have during the past summer experimented upon a number of dogs, of which the following is but the partial summary of results. In all of the experiments the part to be operated upon was cleanly shaven, the skin thoroughly scrubbed with soap, brush, and water, then with bichloride, and the area protected with bichloride towels. The instruments and the hands of the surgeon received the most careful attention. The wounds were washed with from 1-1000 to 1-2000 bichloride solution and closed, some- times with catgut drainage, but usually without any drainage. Ether was used in each case. From my experience with dogs I am very decidedly of the opinion that it is impossible to secure thorough antisepsis with the care which it is pos- sible to obtain from ordinary attendants. The wounds were dressed with iodoformized collodion, but to retain an antiseptic dressing is impossible in most of the regions of a dog’s body. The persistent and indefatigable efforts which most of these animals exhibit to displace and remove the bandages are prodigious. In the limbs encasement by gypsum bandages is sometimes advantageous. I believe, therefore, that the tongue of a dog, applied, as it usually is, with such constant frequency to a wound, offers ordinarily as good hope of quick recovery as can be obtained under poorly- maintained asepsis. With perfect laboratory arrangements, of course, asepsis is possible, but these surroundings are ordinarily unattainable. Experiment No. I.—Nerve-resection: suture. Black pup. The region over the sciatic nerve posterior to the great trochanter was rendered thoroughly aseptic as above described. An incision was made dividing the fibres of the muscle longitu- dinally, and one-quarter of an inch of the nerve was resected. The divided ends were stitched with fine chromicized catgut, using a round sewing-needle, the ends of the nerve being purposely left a quarter of an inch apart. The sutures were intro- duced crossing each other at right angles. The nerve was disturbed as little as possi- ble. The muscles and skin were sutured separately, and the wound was cleansed and closed with iodoformized collodion. On the following day I was astonished to find that the dog was able to walk and even to skip about, apparently having but little concern about the operation, although I was certain that I had divided the entire nerve. Subsequent events proved, how- ever, that a portion of it had been left uncut. The next day under ether I removed three-quarters of an inch of the left sciatic, dividing also the branch which ran to the gluteal muscle. A compact bundle of four strands of catgut was stitched between the two ends, thus bridging the gap for the original distance of three-quarters of an inch. The wound was closed as on the other side. On the fourth day there were no signs of suppuration on either side. The wound on the right side appeared to have united by first intention. On the ninth day the wound on the right side was almost entirely healed, being covered only with a slight scab. There was no paralysis on the right side, no drop of the foot or toe. The limb was apparently almost normal. On the left side there was paralysis of the extensors of the toes, and the pup was walking upon the dorsum of the foot,—that is, in a condition of extreme equinus, though the limb was well handled and the animal was able to run quite briskly, save for the toe-drop alluded