TENDON TRANSPLANTATION AND NERVE ANASTOMOSIS
American Journal of the Medical Sciences
WOUNDS of nerve trunks, with the paralyses resulting therefrom, have been numerous during the campaign in East Africa, and the application of the right treatment for each case, has been one of the most interesting of , tpe surgical problems submitted to us; The station in life of each patient, his cl;lances 6f being able to continue treatment after leaving hospital, and his ability or otherwise; to get efficient apparatus have ,all been factors in deciding on the class of operation applicable."
... ration applicable." " \ ' . In the operative treatment of nerves and paralysed muscles in this Force we have been guided by the work of Major-General SirHobert J ones on poliomyelitis;" and we have successfully applied his methods of tendon-transpl~n~ation and fitationin cases unsuitable for nerve suture, or in cases in which nerve suture had failed. Many such operations on paralysed and useless lirpbs havebeeri ,carried ont, and though none can be said to have actually failed, there is n' o doubt that' our later. caseshaye bee~l more unifoi-Inly successful as ,regards end results. 'l'he, production of these improved results has, been attained by certain modifications in our original methods, 'and I will endeavour to describe those modifications in the text and to explain their rationale. ' , Tendon Transplantation.~Thisoperation has been carried outi'n this Force for three types of nerve injury :-' (aL Irrepa.rable injury to the musculo-spiral nerve with wrist-drop. (b) Similar injury to the median nerve.' , . (c) Injury to the musculo"cutaneousnerve in the leg with paralysis of the'peronei muscles and resulting pes equino varus. , Before describing ·the ,'operations carried out, and the modifications which we bavefound u'seful, let me state that in certain disabilities, due to severance of a nerve-trunk; and especially in the paralysis due to.division of, the musculo-spiral nerve, one is justified in recommending the operation of tendon transplantation in preference to that of secondary nerve suture. , I t,hink that this is probably the case even for British officers and men, while for the Indian and African soldier, and the porter, who want useful Bands quickly, and who cannot, and in most cases certainly will not, carry out 'the long months of treatment .essential for a successful result after l:i'erve srit~re, I a~ certain that tendon transplantation is the operation of election. As regards' usefulness to the Force, too, tendon transplantation is preferable, asit will return men with useful hands to the ranks in two 'or three months. Such a result is hnpossihle after nerve suture.