. Modern surgery, general and operative. ng boric acid. Formerly I did not open the subclaviantriangle. I believed that these glands wereinvolved from the axillary lymphatics only,that when they were involved the mediastinalglands were sure to be affected (the route tothem being more direct) and that operation was certain to be useless. When thesubclavian glands are involved from the axillary lymphatics this is true, but insome cases they are involv ed by way of the direct lymph paths from the mam-mary gland. In such a case the mediastinal glands may be free, and cleaningout the subclavian tri
. Modern surgery, general and operative. ng boric acid. Formerly I did not open the subclaviantriangle. I believed that these glands wereinvolved from the axillary lymphatics only,that when they were involved the mediastinalglands were sure to be affected (the route tothem being more direct) and that operation was certain to be useless. When thesubclavian glands are involved from the axillary lymphatics this is true, but insome cases they are involv ed by way of the direct lymph paths from the mam-mary gland. In such a case the mediastinal glands may be free, and cleaningout the subclavian triangle may save the patient. I always open the subclaviantriangle and clear out fat and glands if no glands or only a few small glandshave been palpable before operation. If there be a large glandular mass inthe triangle, operation is useless. I always open the triangle if the tumor of themammary gland is in the upper hemisphere, or if I discover enlarged glandsat the apex of the axilla, whether there are or are not small palpable glands. Fig. 1097.—Warrens incision for re-moval of the mammary gland. 1592 Diseases of the Mammary Glands above the clavicle. An .t-ray examination of the mediastinum should be made,before deciding upon operation (see page i6i2). The Younger Senns Incision.—A very useful incision is that describedby the younger Senn, and shown in Fig. 1094. The breast is circumscribedbv two curvilinear incisions which meet above, at the border of the great pec-toral muscle. The incision is continued a little internal to the outer border ofthe muscle to about i inch above the apex of the axilla, when it is curved out-ward in the deltoid region, and terminates at the level of the apex of the breast is removed from the wall of the chest, and is then suspended byaxillary glands and fat, which are removed en masse} This ihcision gives afree exposure, opens the axilla from in front, enables the surgeon quickly tolocate and freely to expose the axillary vein,
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