Licence: Public Domain Mark
Credit: Surgical operations / by Sir William MacCormac. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![aside. The sheath of vessel will then be exposed, the vessel may be isolated, and a ligature applied in the usual manner, excluding the venae comites. Below the middle of the arm the median nerve lies on the inner side, and the needle should therefore be passed from within outwards. The frequent variation in the relations of this artery must be re- membered. It often bifurcates high up, and one division may be super- ficial to the aponeurosis of the arm. The mobility of the neighbouring parts is considerable, and the sheath can readily be drawn aside by the retractor. If the incision be made too much internal the ulnar nerve will be exposed, and may be mistaken for the median. LIGATURE OF THE BRACmAL ARTERY IN THE UPPER THIRD OF THE ARM. Surgical Anatomy.—The vessel lies on the inner aspect of the arm, covered by the integument and deep fascia, and overlapped by the basilic vein. The coraco-brachialis muscle and median nerve are on the outer side; the basilic vein, the ulnar and internal cutaneous nerves are on the inner side. Guide.—Edge of the coraco-brachialis muscle. Operation.—Abduct the arm. Make an incision three inches in length (Fig. 46) close to the border of the coraco-brachialis ; the steps otherwise are similar to those in the middle third. The needle should be passed from the outer side, and great care taken that nothing save the vessel is included in the ligature. Collateral Circulation (Fig. 52.) Brachial, above the origin of superior profunda. J Ascending branches of superior Branches of circumflex {posterior) with-y profunda. Brachial, below the origin of inferior profunda. Superior profunda {a) by termination with Radial recurrent. {b) by posterior ar- \ f Reairreiit interosseous at back ticular branch]'^^ ' t of joint. ... ( Afiastomotica magna. Inferiorprojunaa with | p^^^.^^^^ recurrent.](https://iiif.wellcomecollection.org/image/b21979431_0068.jp2/full/800%2C/0/default.jpg)
