The Operative Findings in Thirty Cases of Gunshot Injury of Nerves, with Remarks on Diagnosis, Localisation, and the Technique of Operation

Somerset in the Southern Command. cases of complete division of the nerve the ends may lie quite apart, and the proximal end, as is well known, often has quite a marked bulb on it. This bulb is generally adherent by scar tissue to the surrounding structures, as is also the distal end of the nerve. But in some cases of complete division the ends are united by a bridge of scar tissue. This bridge may not at all resemble the nerve in shape, it may (as in one of my cases of divided sciatic nerve) be quite a flat band, but in some cases it may not be at all easy to be sure whether the nerve is actually divided and bridged by scar tissue, or whether what looks like scar tissue really a continuation of the nerve with scar tissue around, and the nerve thickened by sclerosis. We must not expect "to find the divided ends of the nerve always separated by a gap, though we often do, and it is the nature of the intervening tissue, between what is obviously nerve, that is often a difficult matter to determine. A very marked bulb on the proximal side of what seems to be only a bridge of scar tissue