A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior Practitioners — John Shaqi
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
The late Mr. Furner of Brighton reported a most interesting case,
in which he tied both subclavian arteries at an interval of two
years in the same patient, for axillary aneurisms, with success.
LIGATURE OF AXILLARY.--_Anatomical Note._--This vessel, the next stage
in the continuation of the subclavian downwards, may be defined
surgically as extending from the clavicle to the lower border of the
teres major. From the depth of the vessel at its upper part, the
numerous nerves, and the close proximity of the vein, the surgeon has
carefully to study the anatomical relations. It, like the subclavian, is
commonly divided into three stages, and, also like the subclavian, these
stages are defined by the relations of the artery to a muscle, the
pectoralis minor. Surgically we may draw a very close parallel between
the two vessels, for we find that in the axillary, as in the subclavian,
the first stage is very deep, and very rarely amenable to ligature; the
second, still deeper and more rarely attempted, as in both the operation
involves division of a deep muscle; while the third stage in each is the
one most frequently chosen by the surgeon.
_First Stage._--Between the lower edge of the first rib and upper border
of the pectoralis minor the vessel is deeply seated, contained in that
process of deep fascia called the costo-coracoid membrane, and covered
above by skin, platysma, and the clavicular portion of the pectoralis
major. It lies on the first intercostal muscle and the upper digitation
of the serratus magnus, while the cords of the brachial plexus are on
its acromial side, and the axillary vein in close contact with it on its
thoracic side, and frequently overlapping the artery.
_Operation._--The great desideratum is free access. An incision (Plate
I. fig. 9), semilunar in shape, with its convexity downwards, must
extend from half an inch outside of the sterno-clavicular articulation
to very near the coracoid process, stopping just before it arrives at
the edge of the deltoid, in order to avoid injury of the cephalic vein.
It must include skin, fascia, and platysma, and the flap must be thrown
upwards. The clavicular portion of the pectoralis major must then be
divided right across its fibres, which will retract. The arm must then
be brought close to the side to relax the pectoralis minor, which must
be drawn aside. The artery will then be felt pulsating, but hidden by
the costo-coracoid membrane, which acts as its sheath. This must be
carefully scratched through, the nerves pulled outwards, the vein
avoided and pulled downwards and inwards, and the thread passed round
from within outwards. (Manec, Hodgson, and, with slight modification in
the incision through the skin, Chamberlaine.)
Ligature has been performed in this position by separating the
pectoralis and deltoid muscles, without dividing the muscular
fibres (Roux, Desault).
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account