A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior PractitionersBell, Joseph
Science
A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior Practitioners
Bell, Joseph
Surgery, Operative
_Right Subclavian._--The innominate artery divides into the right
subclavian and right carotid exactly behind the sterno-clavicular
articulation. The right subclavian extends from this point in an arched
form across the neck, between the scalene muscles, over the apex of the
pleura, till, passing under cover of the clavicle, it changes its name
to axillary at the lower end of the first rib. For convenience of
description, the artery is divided into three parts, which have very
various anatomical relations, and differ from each other much in their
amenability to surgical treatment by ligature. The anterior scalenus
muscle defines the three parts, the first extending to the inner border
of the muscle, the second being concealed by the muscle, and the third
reaching from its outer border to the lower border of the first rib.
_Branches of the Subclavian._--While the deep relations of pleura,
veins, and nerves can be noticed under the head of each operation in
detail, one anatomical point must never be forgotten as influencing very
much the success of all surgical interference with the subclavian
arteries--_i.e._ the branches given off. To give any chance of success
in the application of a ligature to such a large vessel, so near the
heart, a large portion of artery free from branches is required, that
the clot may be long, firm, and undisturbed. The first part of the
subclavian gives off the vertebral, thyroid axis, and internal mammary;
the second, the superior intercostal; while the third part has in most
cases no branch whatever. In these anatomical differences we find the
reason for the almost invariable fatality resulting on any interference
with the first and second parts, and the comparative safety of ligature
of the third part, without requiring to account for the difference on
other grounds, such as depth of part, importance of nervous relations,
or nearer proximity to the heart.
The second and third parts of both arteries are so similar to each
other, that a separate account is not required for the two sides.
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