A treatise on orthopedic surgery . at the junction of its middleand lower thirds, downward and outward to the clavicle at thejunction of its middle and outer thirds. After the skin,platysma and deep fascia are divided, the omohyoid muscle is ^ Brit. Med. Jour., 1903, p. 298. = A. S. Taylor, J. Am. Med. Assn., Vol. 48, No. 2. 504 OETHOPEDIC SUEGEPiT. exposed near the clavicle, and lying beneath it are the supra-scapular vessels. These structures may be retracted downward,or, if the case requires the extra room, the omohyoid may bedivided, and then the vessels cut between double ligatures. Thetr
A treatise on orthopedic surgery . at the junction of its middleand lower thirds, downward and outward to the clavicle at thejunction of its middle and outer thirds. After the skin,platysma and deep fascia are divided, the omohyoid muscle is ^ Brit. Med. Jour., 1903, p. 298. = A. S. Taylor, J. Am. Med. Assn., Vol. 48, No. 2. 504 OETHOPEDIC SUEGEPiT. exposed near the clavicle, and lying beneath it are the supra-scapular vessels. These structures may be retracted downward,or, if the case requires the extra room, the omohyoid may bedivided, and then the vessels cut between double ligatures. Thetransversalis colli vessels are seen a little below the middle ofthe wound and are divided between double ligatures. The dissection is rapidly carried through the fat layer to thedeep cervical fascia covering the brachial plexus, which fasciais usually thickened and adherent to the damaged nerve fascia is divided in the line of the original incision andis dissected away for the free exposure of the nerves (Fig. Fig. Operation for relief of brachial paralysis. (Taylor.) A, scalenus anticusmuscle. B, phrenic nerve. C, internal jugular vein. D, transversalis colliartery. E, seventh root. F, omohyoid muscle. G, fifth root. H, scalenusmedius muscle. I, sixth root. ./, transversalis colli artery. K. suprascapularnerve. L, external anterior thoracic nerve. AI, clavicle. X, nerve to subclavius. 333). The damaged nerves are usually noticeably thickenedand of greater density than normal nerves. The extent anddistribution of the paralysis, determined before operation, givesthe clue as to which nerves are at fault. Usually the junctionof the fifth and sixth roots is the site of maximum thickened indurated areas are determined by palpation DEFOBMITIES OF TEE UPPEE EXTEEMITY. 505 and are excised bj means of a sharp scalpel. Scissors shouldnever be used for this work. The nerve ends are brought into apposition by lateral suturesof fine silk involving the nerve sheath
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