Operative surgery . ion with flexion and pro-nation of tlie forearm should limit as much as possible any destructive inter-ference with it. The Fallacies.—The arteries of the forearm may come from the axil-lary, or the brachial may bifurcate high up, thereby increasing the numberof the large vessels in the arm. This fact is determined by the compara-tive size of the brachial, and the influence of pressure on its circulation atthe distal side of the proposed ligature. The brachial artery may run behindthe inner condyle along with the ulnar nerve. If the artery be not in itsnormal site, deep pre
Operative surgery . ion with flexion and pro-nation of tlie forearm should limit as much as possible any destructive inter-ference with it. The Fallacies.—The arteries of the forearm may come from the axil-lary, or the brachial may bifurcate high up, thereby increasing the numberof the large vessels in the arm. This fact is determined by the compara-tive size of the brachial, and the influence of pressure on its circulation atthe distal side of the proposed ligature. The brachial artery may run behindthe inner condyle along with the ulnar nerve. If the artery be not in itsnormal site, deep pressure on the arm may detect arterial pulsation else-Avhere, which, together with the effect of the pressure on the circulation be-yond, will determine the size and site of the vessel. Each of the pro-funda branches has been mistaken for the main vessel. The incision at theupper two thirds may be made too far inward, causing the surgeon to mis-take the ulnar for the median nerve. If the forearm be flexed and gentle. Fig. 221.—Transverse section of right arm at the middle third. A. Superior profunda artery and veins. B. Musculo-spiral nerve. C. Cephalic Musculo-cutaneous nerve. E. Brachial artery and veins. F. Median Internal cutaneous nerve. H. Basilic vein. /. Ulnar nerve. upward traction be made upon either, the course of the nerve will be deter-mined, and the danger of this will be easily avoided. The median nerve may pass behind the artery instead of in front of it;then, if the circulation from above be obstructed, the artery may escape 184 OPEEATIVE SURGERY. BRACHIALIS ANIICUS M. MUSCULO-CUTANEOUS N. SUPINATOR LONGUS M. TENDON OF BICEPS. BADIAL VENfE LONGUS RADII TERES CARPI RADIAL IS M. BADIAL A. WITH VEH/E COMITESRADIAL LONGUS POLUCISSUPINATOR LONGUS FLEXORCARPI RADIALIS RADIAL „,[jp;:p TENDON OF FLEXOR CARPI fl/lDML/sJjN PRIMI lINTERNOQll POLUCIS. ) SUPERFID
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