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Show or wommnn annexes. n-nhw... «up..- ._...-. 5,, "cur-r- x . _,-y‘.- .1, »‘_-- ... .. a: 26‘) 0F VVOUNDED ARTER! ES. To cut for the subclavian artery, I begin the incision an inch from the inner head of the clavicle; I carry it in a di~ rection slightly deviating from the line parallel with the clavicle, towards the acromion scapulae. My second incision cuts the fibres of the pectoralis major, where they arise from the clavicle; I here come upon a thick bed of cellular membrane, which being lifted, I find the great subclavian vein, with the cephalic vein joining it; under this vein, and a lit- THE humeral artery does not run a perfectly straight course down the arm. When the subject is laid on its back the arm by the side, and the palm of the hand flat upon the'table if we push a point horizontally under the arm bone, one hands' breadth from its head, the artery escapes. When in the tle,further backward (more under the clavicle) I feel the sub- same horizontal direction, two hands' breadth from the head clavian artery, and can put a ligature around it; the nerves of the bone, the artery is transfixed. Lower down the arm the artery again rises towards the fore part of the humeru s. , ~ .To find the humeral artery before passing over the elbow JOlIIt, we make the patient bend the other arm against a force to show the expansion of the biceps. Having marked it; are behind the artery. N. B. If there should be a dangerous haemorrhagy from the axilla, and the patient big and muscular, and the compression inell‘ectual; by making such an incision as is here described, (or perhaps somewhat less extensive, but suthcient to allow the finger to go through the clavicular portion of the peetoralis muscle) we shall be enabled, with much ease, to put the point of the finger on the artery, and press it against the rib, until the vessel in the axilla be secured. TIIE LO‘VER PART OF THE AXILLARY ARTERY, 0R BEGINNING OF THIS HUMERAL ARTERY. Ir we have to turn up the edge of the pectoralis major, to tie the axillary artery, we find the artery on the inside of ‘1‘, the coraco brachialis ; the external cutaneous nerve is on the (gt-(""7- -WM~W._N.‘ _.-, THE HUMERAL ARTERY LG‘VER IN THE ARM. outside of the artery, the radial nerve on the inside and the muscular spiral below it; the vein is betwixt the artery and the muscle; higher up in the axilla the artery is involved in the plexus. I need not repeat, that in these descriptions of the exact ‘ seat of the arteries I intend that they should enable the surgeon to avoid them, as well as to out upon them and take them up. By attending to the above circumstances I cut a ragged ball out from behind the artery and nerves without hurting either. place, we refer it to the wounded arm, and make an incisio n along the inner edge of the biceps, or rather, we might say Just where it begins to throw off its tendinous expansion, that, is, two fingers' breadth from the inner condyle of the 0s humeri, and carry the knife upwards. We do not immediately find the artery, but the radial nerve covering the artery ; laying the nerve aside, we find the artery lying betwixt its two venre comites. THE RADIAL ARTERY. To find the radial artery in its course one third down the arm,-cut on the inner edge of the supinator [022mm, first through the thin fascia-then lift the edge of the muscle, and under a second fascia you find the radial artery, passing over the tendon of the pronutor tcres. 1. To take up the radial artery on the wrist, we cut a quarter of an inch from the radial edge of the Flavor Carpi Radialis. A fascia covers the artery here. A small nerve (from the external cutaneous) runs above the fascia. N. B. The insertion of the Supinator Radii Longus is on the outside, but tlat, giving no mark outwardly. The Extcnsor Primi Internodii Police‘s comes obliquely over the head of the Ra- dius, and the insertion of the Supinator. v" F -‘- 'l'r-‘r'rrw. I ' x c;. ‘ 7va Moss |
