Operative surgery . sels. In liberating the vein fromthe tissues to be removed, it is best to push the vein away from the tissues,rather than hold the vein and push the tissues away from it. It may not70 1012 OPERATIVE SURGERY. always be necessary to expose the artery, but I think that it is well to dothis, for sometimes, not usually, the tissue above the large vessels is infil-trated, and we should not trust our eyes and fingers to decide this is best to err on the safe side, and to remove in all cases the loose tissueabove the vessels and about the axillary plexus of nerves. 13. Hav
Operative surgery . sels. In liberating the vein fromthe tissues to be removed, it is best to push the vein away from the tissues,rather than hold the vein and push the tissues away from it. It may not70 1012 OPERATIVE SURGERY. always be necessary to expose the artery, but I think that it is well to dothis, for sometimes, not usually, the tissue above the large vessels is infil-trated, and we should not trust our eyes and fingers to decide this is best to err on the safe side, and to remove in all cases the loose tissueabove the vessels and about the axillary plexus of nerves. 13. Having cleaned the vessels, we may proceed more rapidly to stripthe axillary contents from the inner wall of the axilla—the lateral wall ofthe thorax. We must grasp the mass to be removed firmly with the lefthand, and pull it outward and slightly upward with sufficient force to puton the stretch the delicate fascia which still binds it to the chest. Thisfascia is cut away close to the ribs and serratus magnus Fig. 1389.—Excision of the breast, llalsteds inelhod. a. Reflected part of peetoralisminor muscle, a. Central part of peetoralis minor muscle, h. Humeral insertionof sternal portion of peetoralis major, b. Severed part of sternal poi-tion of pee-toralis major, c, r. Fatty prolongations bearing lymph nodes. 14. When we have reached the junction of the posterior and lateralwalls of the axilla, or a little sooner, an assistant takes hold of the triangularflap of skin and draws it outward, to assist in spreading out the tissueswhich lie on the subscapularis, teres major, and latissimus dorsi operator having taken a different hold of the tumor, cleans from withinoutward the posterior wall of the axilla. Proceeding in this way, we makeeasy and bloodless a part of the operation which used to be troublesome andbloody. The subscapular vessels become nicely exposed and caught beforethey are divided. The subscapular nerves may or may not be removed, atthe discre
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