Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . isease of breast. THE BREAST 483 and upper arm. The preparation of the skin, and the handling of the tumorbefore and during the operation should be so gentle that no cancer-cells areforcibly dislodged and sent into the lymph-channels. This is one of the dan-gers of operation. AH manipulations should be governed accordingly. Thehand and forearm should be enveloped in towels, and held at a right angle tothe body or rested upon a table. It is well to have a protectin
Surgical treatment; a practical treatise on the therapy of surgical diseases for the use of practitioners and students of surgery . isease of breast. THE BREAST 483 and upper arm. The preparation of the skin, and the handling of the tumorbefore and during the operation should be so gentle that no cancer-cells areforcibly dislodged and sent into the lymph-channels. This is one of the dan-gers of operation. AH manipulations should be governed accordingly. Thehand and forearm should be enveloped in towels, and held at a right angle tothe body or rested upon a table. It is well to have a protecting screenbetween the anesthetists apparatus and the field of operation. If diagnostic exposure of the tumor is to be made the incision should beginat the breast; otherwise it should begin at the arm. In the typical case,the incision should pass from the pectoralis insertion to the inner side of thebreast (Fig. 1153). This should be joined above the axilla by the outerarm of the incision, extending from the outer side of the breast. These in-cisions are carried down to the subcutaneous fat, and obliquely away from 1 ?&?. Fig. 1153.—Incision for Cancer of Breast. The first part of the incision is shown by the solid lines. The incision indicated by the dotted lines is made after the axilla has been dissected. the wound, down to the fascia lying upon the muscles. The skin and sub-cutaneous tissues are then undermined and dissected free as far as the outerend of the clavicle and the middle of the sternum; and externally, the axillaand outer thorax should be uncovered as far as the latissimus dorsi tissue should be left so as not to destroy the nutrition of the fairly advanced cases the subcutaneous fat in the regions where thelymphatics run, especially between the tumor and the axilla, should beremoved. The insertion of the pectoralis major muscle is then exposed, the fingerpassed under it, the sternal and costal fibers divided (Fig. 1154), and thestump reflec
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Keywords: ., bookcentury1900, bookdecade1920, booksubjectsurgery, bookyear1920
