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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    Experiment No. IV.— Nerve-flap splicing. Black Newfoundland dog. Half an inch of the right sciatic was cut away, and the nerve slit for a half-inch, commencing one-quarter of an inch from the end. Flaps were then cut upon the opposite sides, turned and sutured end to end, leaving the original ends three-quarters of an inch apart. Three days later the wound had entirely healed. The dog was walking with paralysis of the extensors of the toes and on the dorsum of the foot, in a condition of extreme equinus. He was killed on the twenty-fifth day by chloroform. The nerve was found in proper position and adherent to the cicatrix. The continuity of the nerve was ap- parently entirely restored. Around the nerve was marked thickening throughout the extent. Above and below the calibre appeared to be slightly narrowed. Experiment No. V.—Nerve-resection. Catgut bridge inserted. Small bitch pug. Technique as before. Three-quarters of an inch of the right sciatic was removed and a bundle of four strands of catgut was sutured in position. The wound was dressed as before. On the tenth day the silk-worm skin-stitches had nearly cut through, being removed by the dog. The wound had opened and the dog was quite lame, apparently from soreness. She could walk, but the toe dropped. On the eleventh day she was feverish and refused food, and was killed on the fourteenth day, as she was losing flesh rapidly. Small patches of miliary tubercle were found throughout both lungs, which evi- dently had existed previously to the operation, as it was noticed that the animal was in poor flesh and spirits. The nerve above and below the point of section for a quar- ter of an inch was removed. No appearance of the catgut bridge was visible, it probably having been removed after the wound opened. There was but a slight con- nective-tissue bridge. The wound was still open. Microscopical Appearances.—Upper fragment terminates in connective tissue, the nerve breaking up into fibrils. Below this there is about an inch of fibrous tissue containing groups of fibres here and there, in which the myeline is in drops showing advanced degeneration. A few muscle- fibres are found in the connective tissue. No undegenerated fibres could be found in this mass of connective tissue. At the lower end of the section the bundle of nerve-fibres are all grouped together, and show a beaded condition of the myeline, but apparently the degeneration is not so far advanced as that seen above. Experiment No. VII.—Nerve-splicing; large bitch pug, old and very fat. The left sciatic was divided, and three-quarters of an inch of the nerve removed. The nerve was then slit longitudinally and the flaps turned upon their bases. One tore out and left only the upper half of the flap. This, however, was turned downward, and stitched to the upper slit half of the lower fragment. Nine days later the wound was perfectly healed and the animal was running with ease and comfort; the toes dropped, however, and she stepped upon the dorsum when attempting to run rapidly. Three-quarters of an inch was removed from the right sciatic, and the nerve thoroughly cleared, stitched, and sutured end to end. On the next day the animal appeared heavy and feverish, and refused water. The weather was extremely hot. The animal was very old, and on the following day, without any assignable cause, was found dead in the kennel. There were no symptoms of tetanus. At the seat of the first operation (left) there was an irregular connective-tissue bridge, but the point from which the flap was taken had become bulbous. The flap