Remarks on nerve-grafting : read in the Section on Surgery at the Annual Meeting of the British Medical Association, held in Birmingham, July, 1890 / by Edward Atkinson.

  • Atkinson, E. (Edward)
Date:
[1890]
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Licence: Public Domain Mark

Credit: Remarks on nerve-grafting : read in the Section on Surgery at the Annual Meeting of the British Medical Association, held in Birmingham, July, 1890 / by Edward Atkinson. 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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    Sepriiited for the Author from tlie British Medical Journal, Sept. 13, 188J. REMARKS ON 'NERVE-GRAFTING.^ Read in the Section of Surgery at the Annual Meeting of the British Medical Association, held in Birmingham, July, 1890. By EDWARD ATKINSON, M.R.C.S., Senior Surgeon Leeds General Infirmary. This operation was, I believe, new to surgery when my colleague, in January of last year, communicated to the Clinical Society of London an account of the first case in which he had performed it, and exhibited his patient. Experiments in grafting nerves in the lower animals may have been previously made in other countries, but of this I am not sure. To Mr. Mayo Rohson, I believe, is due the credit of having devised and performed it in the human sub- ject. Since then several other cases have been undertaken in the Leeds General Infirmary, presenting considerable variety. It seems to me, therefore, desirable to review these cases, the different circumstances under which the operation has been per- formed, the modifications of procedure, and the results obtained. Nerve-grafting consists in the insertion of a fresh piece of nerve, newly taken from man or animal, into the gap left by the removal or destruction of a portion of a nerve in its continuity, whether by design or accident, and in suturing it into position. This has been done five times in all here—twice by Mr. Robson, once by Mr. Ward, and twice by myself. Of these, one (Mr. Robson’s first case) was performed forty-eight hours after division of the median while removing a neuroma. Two were deliberately planned; the one for tumour involving a nerve, the other for paralysis due to an old cicatrix. The remaining two were done under emergen- cies; the first for the accidental removal of a portion of the sciatic nerve while excising the hip in a child—where the same piece was replaced in its former position; and the second was for a lacerated wound 'of forearm, involving the destruction of two inches of the ulnar nerve. In all five cases, sensation, entirely lost before, began to be restored after an interval varying from thirty-six hours to eighteen days, and steadily improved. I will now relate the cases as briefly as I can, and afterwards offer a few remarks upon them. The first, having been already published,'^ I will only sketch, if I may, very cursorily. Case i.—M. B., a girl, aged 14, came under the care of Mr. Rob- son in September, 1888, for a tumour the size of a hen’s egg on the right forearm, which had been growing six years. It was situated just above the wrist, and, being a source of great inconvenience as well as deformity, she sought for its removal. Upon incising the integuments, the tumour bulged through the wound, and was easily separated from its cellular bed, leaving the mass attached above and below to a cord which appeared to be inseparably blended with it ; the attachments had therefore to be cut through. The microscope showed the cord to be composed of nerve tissue, and, on the patient recovering from the anaesthetic. > British Medical Journal, February 2nd, 1889.
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