. Modern surgery, general and operative. years, used to open the axilla first when there was an axillary mass, but he didit in order to determine in the beginning of the operation if the axillary mass wasreally removable. Willy Meyer emphasizes the value of his procedure in les-sening hemorrhage. In Meyers operation two flaps are formed by the skin-incision (Fig. 1098)—a lower and an upper flap. The incision for the formationof the lower flap begins at the point of insertion of the great pectoral muscleon the humerus, and is carried downward and inward 3-^ inch above the borderof the muscle an
. Modern surgery, general and operative. years, used to open the axilla first when there was an axillary mass, but he didit in order to determine in the beginning of the operation if the axillary mass wasreally removable. Willy Meyer emphasizes the value of his procedure in les-sening hemorrhage. In Meyers operation two flaps are formed by the skin-incision (Fig. 1098)—a lower and an upper flap. The incision for the formationof the lower flap begins at the point of insertion of the great pectoral muscleon the humerus, and is carried downward and inward 3-^ inch above the borderof the muscle and parallel to it. When the incision reaches the base of themammary gland, it is carried along the lower margin of the gland, and it endsover the sternum, a little beyond the midline (Fig. 1098). The lower flap isseparated and turned down, a quantity of subcutaneous fat being allowed toremain attached to the breast. This turning down is carried to the borderof the latissimus dorsi muscle, to the axillary cavity, and to the chest Fig. 1099.—Willy Meyers operation for carcinoma of the breast. Insertion of pectoralismajor muscle exposed. Operators left index-finger encircling its tendon. Meyer then directs that the border of the latissimus dorsi be followed down tothe serratus anticus major, and upward to the mass of fat that enters the bicipi-tal sulcus of the arm. The fat is removed from the anterior border of the muscleby blunt dissection. This anterior lower wound is then packed with gauze. The surgeon next forms the upper flap by uniting the inner and outer endsof the first incision with another incision carried along the upper margin ofthe breast (Fig. 1098). In this flap, as in the other, the surgeon leaves asmuch subcutaneous fat adhering to the breast as he can spare without in-ducing the danger of skin necrosis. This upper flap is raised progressivelyuntU the cephalic vein is reached and there is exposure of the lower surfaceof the clavicle with the sternoclavi
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Keywords: ., bookcentury1900, bookdecade1910, bookidmodernsurger, bookyear1919
