. Medical and surgical therapy . Fi(j!. oo.—Arterial topograjJiy of tluupper limb. (Broca.) (fig. 56). Whena tourniquet isemployed thepatient should begot at the earliestpossible momentto a field ambu-lance, and theredirect haemostasisin the woundshould be at oncesecured. Diffuse hsema-toma anywhere inthe arm is fre-quent. It has nosurgical interest,however, unless itis situated in theextreme upperend of the limband proceeds froman arterial woundbetween the originof the circumflexand the superiorprofunda. Herethe anastomosesare very scanty,and should thehaematoma attaindimensions suffi-cient t
. Medical and surgical therapy . Fi(j!. oo.—Arterial topograjJiy of tluupper limb. (Broca.) (fig. 56). Whena tourniquet isemployed thepatient should begot at the earliestpossible momentto a field ambu-lance, and theredirect haemostasisin the woundshould be at oncesecured. Diffuse hsema-toma anywhere inthe arm is fre-quent. It has nosurgical interest,however, unless itis situated in theextreme upperend of the limband proceeds froman arterial woundbetween the originof the circumflexand the superiorprofunda. Herethe anastomosesare very scanty,and should thehaematoma attaindimensions suffi-cient to compressthe neighbouring WOUNDS OF VESSELS OF ARM, ETC. 217 vessels, gangrene of the arm is a possible termina-tion. Two such cases have been described byMurard. It should be noted, however, that thegangrene in these two cases was both mechanicaland septic—a variety in the etiology of which in-fection is a preponderating factor. Lower down the arm the anastomoses are numer-ous. At the elbow they form a peri-articular net-. FiG. 56.—Digital compression, of the brachial artery.(After Farabeuf.) work of considerable importance. It follows thatligature of the main trunk at this point is of onlyslight importance, for the circulation of the arm isassured in advance. A further consequence of thecomplexity of the vascularisation of the arm andelbow lies in the frequent multiplicity of the vascularwounds. In addition to the brachial artery and vein,it may be necessary to tie the median basilic vein,one or more radial or ulnar recurrent, or the inter-osseus vessels. Arterial wounds of the arm are some-times accompanied by nervous lesions. In associationwith a wound of the brachial arterv there mav be a 218 WOUNDS OF THE VESSKLS lesion of the median or ulnar nerve ; in the case ofthe superior profunda, of the radial (niusculo-spiral). The clinical course of wounds of vessels of thearm is uneventful. All that has been said concerningthe clinical development of aneurism in general a
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1918
