Anatomy to the surgeon is mainly of interest when it concerns parts that he ordinarily meets. In this respect the diaphragm has only attained an important place in the last 15 years. Before this the abdominal surgeon seldom saw it from below, while his thoracic counterpart was not particularly interested when his main attention was concentrated on the lung. The surgery of the oesophagus has brought these two fields together and has given a new importance to the detailed study of this structure.Our attention was drawn to the importance of. the nerve supply of the crura because of the possibility that the branch to the left half of the right crus might be interfered with during the repair of a hiatus hernia. In order to ascertain if this danger did exist we searched the literature, but no description of the nerve supply of these parts could be found. Much information was obtained about the nerve supply of the diaphragm as a whole, and it was noted that the main controversy had centred around whether or not the phrenic nerves were the sole motor innervation of its musculature. This is an important point which must be settled before confining attention to the phrenic nerve. There is a widely held view that failure to paralyse the diaphragm by a phrenic crush may sometimes be due to the nerve supply reaching the diaphragm by other routes, such as the intercostal nerves. This surgical opinion had much support from earlier anatomical authorities, but would seem to have been completely refuted by the work of Schlaepfer (1926), Jansen (1931, and Strauss (1933).Working on a dog, Schlaepfer sectioned the left phrenic nerve, and after two years killed the animal. All the muscle of the left half of the diaphragm had atrophied and was replaced by fibrous tissue. The line of demarcation between the normal and atrophic areas was clear cut, and he made especial note that this was the case posteriorly. He concluded that the phrenic nerve provided the sole motor supply of the diaphragm. Jansen carried out similar degeneration experiments on goats, and again found that no other nerve supply to the diaphragm existed. The interest in the work of Strauss arises from the fact that he confirmed that the above experiments applied to man. He examined diaphragms from patients who had been treated by phrenic evulsion, and demonstrated that without exception atrophy included the whole of the appropriate side. He also made careful dissections of the nerves and showed that they each divide into three branches, which he followed to the fine filaments only visible with a hand lens. He traced these nerves to the periphery of the diaphragm, and also dissected the intercostal nerves in relation to the attachment of this structure. In this way he proved to his own satisfaction that no branches of the intercostal nerves entered the diaphragm.LOCAL SUPPLY OF THE CRURA It seemed clear from the published work that the nerve supply to the crura could only come from the phrenic nerves, but it was also apparent that no information was available about how t...
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