Ligations and amputations / by A. Broca.

  • Auguste Broca
Date:
1917
Catalogue details

Licence: In copyright

Credit: Ligations and amputations / by A. Broca. Source: Wellcome Collection.

    19/304 page 7
    Chapter II. LIGATURE OF ARTERIES IN THE UPPER LIMB. 1. GENERAL ARRANGEMENT. The Brachial Artery is a large trunk situated on the inner side of the arm. It is found under the internal border of the biceps, accom¬ panied by the median nerve, which passes in front of it nine times out of ten. From its outer side and above, a large collateral vessel takes origin, the superior profunda, which rounds the posterior aspect of the humerus cpiite close to the bone, then leaves it on the outer side, between it and tlie supinator longus, at about the junction of the upper two-thirds with the lower third of the bone. This vessel is not itself exposed to danger, but is accompanied by the musculospiral nerve, which is endangered in fractures of the shaft of the humerus. The posterior and external aspects of the arm may therefore be incised without danger nearly to the bone. To the inner side of the brachial artery and behind, separated by an intermuscular septum, descends the ulnar nerve. These relationships are shown in Figs. 8 and 9, where it is seen that there is a danger zone on the inner side of the arm, where lie the median and ulnar nerves as well as the brachial artery (see also the sections, Figs. 14 and 15). At the Lend of the elbozv (Fig. 9), the brachial artery lies between the biceps tendon externally and the median nerve internally. In front it is separated from the median basilic vein by the semilunar fascia. Posteriorly the elbow is only dangerous to incise on the inner side (Figs. 8 and 9). where the ulnar nerve passes between the olecranon and the internal épicondyle, bony prominences which are easy to feel. In the forearm also, the posterior aspect may be incised without fear of hæmorrhage or the division of a nerve, for all the large vessels and nerves are in front (see Figs. 1(1 to 18). As shown in Fig. 8, at the line of the joint, or one finger-breadth below the inter-epicondylar line, the brachial artery divides into radial and ulnar arteries. The ulnar soon gives off a large inter¬ osseous trunk. 2. LIGATURE OF THE AXILLO-BRACHIAL TRUNK. Course.—For the purposes of operation the axillary artery must be divided into two very different segments : the lower segment, which is approached by way of the axilla, must be studied at the same time as the brachial artery ; the upper segment, which is
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