. Manual of operative surgery. recognizing the upper edge of the pectoralis. Pass the finger around the pecto-ralis major one to two finger-breadths from the humerus. Guided by the finger,divide the pectoralis major. Step 2.—The pectoralis minor now lies exposed to view. Divide this musclenear the coracoid process, and expose the great vessels and nerves of the axilla. Step 3.—Beginning above, near the clavicle and coracoid process, dissect RADICAL OPERATION 277 the fat from the axillary vessels and nerves, and then dissect it free towards thethoracic wall. By this means the most difficult ste
. Manual of operative surgery. recognizing the upper edge of the pectoralis. Pass the finger around the pecto-ralis major one to two finger-breadths from the humerus. Guided by the finger,divide the pectoralis major. Step 2.—The pectoralis minor now lies exposed to view. Divide this musclenear the coracoid process, and expose the great vessels and nerves of the axilla. Step 3.—Beginning above, near the clavicle and coracoid process, dissect RADICAL OPERATION 277 the fat from the axillary vessels and nerves, and then dissect it free towards thethoracic wall. By this means the most difficult step of the operation is com-pleted while the surgeon is fresh, without the annoyance of the loose mass ofmamma, etc., getting in the way, as in the Halsted operation, and while thechest is still protected against chill by its fatty coverings, which will be removedlater. Step 4.—Complete the incision around the breast (Fig. 399). Excise themamma, surrounding fat, and both pectoral muscles. The wound left islarge (Fig. 400).. Fig. 401.—Skin incision. {Meyer.} Step 5.—After attending to hemostasis, close the wound, as much as possible,by sliding the flaps together. Where the wound cannot be closed, cover it withThierschs skin-grafts. Provide for the axillary drainage by a tube introducedposteriorly. After such extensive removal of important muscles one would naturallyexpect very serious loss of function, but such is not the case; the author has beenassured by various patients that they are able to attend to their own houseworkand to dress their own hair satisfactorily. In the Jour. Am. Med. Assoc, July 29, 1905, Willy Meyer published anexcellent series of drawings illustrating his operation; these are so helpful thatthey are reproduced here without comment (Figs. 401 to 406). 278 OPERATIONS ON Till; liREAST
Size: 1381px × 1809px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1920, bookpublisherphila, bookyear1921
