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
_Note._--As in the lower limb at page 24, and for the same reasons,
I here insert a brief account of the methods of tying the ulnar and
radial arteries.
1. LIGATURE OF ULNAR.--Only admissible in the lower half of its
course. _Operation._--Use the tendon of the flexor carpi ulnaris as
a guide, and make an incision along its radial edge, at least two
inches in length; expose the deep fascia of the arm and then
cautiously divide it; then bending the hand, the flexor carpi
ulnaris is relaxed, and the artery is found lying pretty deeply
between it and the flexor sublimis digitorum. The ulnar nerve lies
at its ulnar side, and the venæ comites accompany the artery. In a
tolerably muscular arm, the incision will have to be about an inch
inside of the ulnar border of the limb.
2. RADIAL.--This artery lies more superficial than the preceding,
and may be tied at any part of its course.
_A._ Operation in upper part of fore-arm. Here the artery lies in
the interval between the supinator longus and the pronator radii
teres. In a muscular arm, the edge of the former muscle is the best
guide; in a fat one, the incision may be made in a line extending
from the centre of the bend of the arm to the inner edge of the
styloid process of the radius. The deep fascia must be exposed and
opened, and the muscles relaxed and held aside. The radial nerve
lies on the radial side of the vessel.
_B._ Operation in lower half of arm. Here the vessel is more
superficial, lying in the groove between the flexor carpi radialis
and supinator longus. An incision two inches in length, and
parallel with these tendons, easily exposes the artery. The nerve
is still on its radial side.
_C._ Operation at first metacarpal. The artery may be tied easily
enough in the triangular space bounded by the extensors of the
thumb, on the dorsum of the proximal end of the first metacarpal
bone. Skey[22] recommends a transverse,--Stephen Smith[23] and
others, a longitudinal incision. The author had lately to secure
the radial in its lower third, the superficialis volæ, and the
radial again in the triangular space, in a case where division of
the artery by a transverse cut had caused a large aneurism to form
close above the annular ligament.
TABLE illustrating anastomotic circulation after ligature of
arteries of neck and upper limb.
1. Common carotid.
(_a_) Across middle line: thyroids, linguals, facials, occipitals;
also terminal branches of external carotids; also internal carotids
by circle of Willis.
(_b_) Of same side: occipital with vertebral; superior thyroid with
inferior thyroid, etc.
2. Subclavian, 3d part.
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