The pathology and surgical treatment of tumors . antiseptics are tobe brought in contact with the wound. Gauze sponges should takethe place of marine sponges. The chest of the patient should beraised slightly during the operation, and the body should be inclinedtoward the opposite side. Unless the position of the tumor furnishes a contraindication, theincision should be made in such a manner as to include with the nipplean elliptical piece of skin, and should be carried along the border ofthe pectoralis major to the apex of the axilla (Fig. 200). The necessityof removal of an extensive area of
The pathology and surgical treatment of tumors . antiseptics are tobe brought in contact with the wound. Gauze sponges should takethe place of marine sponges. The chest of the patient should beraised slightly during the operation, and the body should be inclinedtoward the opposite side. Unless the position of the tumor furnishes a contraindication, theincision should be made in such a manner as to include with the nipplean elliptical piece of skin, and should be carried along the border ofthe pectoralis major to the apex of the axilla (Fig. 200). The necessityof removal of an extensive area of skin was strongly emphasized by Gross. He made a circular incision around the breast and madeno attempt to close the wound. This course should be pursued if the CARCINOMA. 315 overlying skin is extensively involved, but if sufficient healthy skinremains, it is better to preserve enough to cover the wound. Thehemorrhage which freely follows immediately the incision is madeshould be controlled by pressure—a duty incumbent upon the assist-. FiG. 200.—Incision for carcinoma of the breast (after Esmarch). ant. The spurting arteries are then secured with compression-forceps,which must be relied upon as a hemostatic until the tumor and theaxillary contents are removed, when every bleeding point is carefullytied with aseptic catgut. The breast with the pectoral fascia shouldbe dissected out first, but should be allowed to remain in connectionwith the axillary glands. The large wound-surface is now coveredwith a compress of gauze during the dissection of the axillary the carcinoma has extended beyond the capsule of the gland at itsbase, parts of the pectoralis major and minor and the serratus magnusand latissimus dorsi muscles may require removal; but such extensiveexcision of muscular tissue as has recently been advocated by Halstedappears superfluous to the writer. The guide to the axilla is the border of the pectoralis major in frontand the latissimus dorsi behind.
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectneoplas, bookyear1895
