. Modern surgery, general and operative. illary and subclavian veins. Meyer advises that the cephalic vein be fol-lowed up until the insertion of the great pectoral muscle into the humerus isfound. The tendon is fully exposed, care being taken to bare it of axillarjfat. The arm is then carried a little nearer to the side to relax the great pec-toral muscle. This tendon is cut off close to the humerus (Fig. 1099). Themuscle is pulled downward and inward and is loosened from the cephaUcvein. It is then cut off near the lower border of the clavacle and the sterno-clavicular articulation. It is ne
. Modern surgery, general and operative. illary and subclavian veins. Meyer advises that the cephalic vein be fol-lowed up until the insertion of the great pectoral muscle into the humerus isfound. The tendon is fully exposed, care being taken to bare it of axillarjfat. The arm is then carried a little nearer to the side to relax the great pec-toral muscle. This tendon is cut off close to the humerus (Fig. 1099). Themuscle is pulled downward and inward and is loosened from the cephaUcvein. It is then cut off near the lower border of the clavacle and the sterno-clavicular articulation. It is necessary to divide the nerves that enter the pec-toral muscle, and all the vessels that come into view are divided between twoclamps and tied. The next step is to divide the tendon of the lesser pectoral muscle near the<;oracoid process (Fig. iioo). Just beneath this tendon lies the subclavianvein. The surgeon now makes a transverse division of the fascia over theaxilla, and thus exposes the axillary and subcla\ian \eins f^Fig. iioi).. Fig. iioo.—Willy Meyers operation for carcinoma of the breast. Finger under tendonof pectoralis minor muscle. Above, cut surface of clavicular portion of pectoralis majorparallel to clavicle is visible (in the living the bellj^ of the pectoralis major is not so thoroughlydetached from that of the pectoralis minor. It is done here to show the latters tendon). Meyers third step is to split the axillary fat over the upper portion of thelatissimus dorsi up to the axllary vein, thus dividing it from the mass of fatthat enters the sulcus bicipitalis brachii. Next, the axillary and the subclavian veins are followed up to where thesubclavian passes below the clavicle, and every vessel that evidently must becut is divided between two Ugatures and tied. This procedure saves a greatamount of hemorrhage. Meyer directs us to be careful to preserve the twosuperior subscapular nerves, although the third subscapular must be sacrificed. The next step in the o
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