. Manual of operative surgery. cle, isolate a suitable bunch of its upperfibres; divide this isolated segment of muscle at itshumeral insertion thus forming a flap with its pedicleposterior. Suture the free end of the flap to theposterior surface of the scapula below the origin of thetriceps. This flap takes the place of the lower fibres ofthe paralyzed trapezius (Fig. 1334). Second Stage.—Through a suitable incision exposethe upper part of the healthy (opposite) its clavicular insertion and carefully preserv-ing its nerve supply form a muscular flap and sutureit (Fig. 1335) t
. Manual of operative surgery. cle, isolate a suitable bunch of its upperfibres; divide this isolated segment of muscle at itshumeral insertion thus forming a flap with its pedicleposterior. Suture the free end of the flap to theposterior surface of the scapula below the origin of thetriceps. This flap takes the place of the lower fibres ofthe paralyzed trapezius (Fig. 1334). Second Stage.—Through a suitable incision exposethe upper part of the healthy (opposite) its clavicular insertion and carefully preserv-ing its nerve supply form a muscular flap and sutureit (Fig. 1335) to the spine of the scapula. Third Stage.—Form a flap (Fig. 1336) from themiddle of the healthy trapezius and suture its free extremity alongside of theflap formed in the second stage of the operation. The result of Katzensteins operation was functionally good. In completeparalysis of the serratus magnus and partial paralysis of the inferior fibres ofthe trapezius Katzenstein devised and carried out the following procedure:. Fig. 1334.—(Katzenstein.)I, 2, 3. Sup. Mid. andInf. Segments of_ Latissimus dorsi. 5. Flapfrom lat. dorsi to trapezius.
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