The Medical and surgical reporter . the house-staff assisting. The incisionmade was that of Langenbeck—see 2. This incision was from and inner angle of the scapula, ex-tending along its spine to the tip of theacromion process. Another incision wascarried at right-angles with this line, tothe inferior angle of the scapula. Thearm was then severed from its attachmentto the scapula. The superior flap wasnow turned upwards, the supra-scapularand posterior scapular arteries beingsecured; the inferior flap was quicklyturned backwards, exposing the posteriorborder of the scapula, w
The Medical and surgical reporter . the house-staff assisting. The incisionmade was that of Langenbeck—see 2. This incision was from and inner angle of the scapula, ex-tending along its spine to the tip of theacromion process. Another incision wascarried at right-angles with this line, tothe inferior angle of the scapula. Thearm was then severed from its attachmentto the scapula. The superior flap wasnow turned upwards, the supra-scapularand posterior scapular arteries beingsecured; the inferior flap was quicklyturned backwards, exposing the posteriorborder of the scapula, which was thentilted forwards and dissected from itsbase, the dissection including all of themuscles attached to the scapula, the in-fra-scapular artery being secured as thedissection proceeded. The scapula wasout away from its attachment to theclavicle, the muscles detached from thecoracoid process and the whole removeden masse. A few bleeding points werenow secured, and the deltoid musclestitched carefully to the fibrous tissue. Fig. s. A. Langenbecks incision showing slough. B. As it should be from an anatomical standpoint. about the end of the clavicle, the headof the bone resting well up underneath 394 Original Articles. Vol. Ixix the acromion end of the clavicle. Thewound was next carefully stitched up anddressed antiseptically, and the wholesuspended in a sling to the side of thebody. The tumor was found attached to thesecond and third ribs quite extensively,and was with very great difficulty sepa-rated ; the time of the operation, includingthe dressings was 57 minutes. There wasno shock, and no higher temperature than101° following the operation. At thefirst dressing, it was discovered that theinferior angular flap had sloughed (see A^fig. 2). This sloughing of the flap wascaused by want of nutrition. The supra-scapular and posterior scapular arteriessupply this portion of the flap and byLangenbeck^s incision they were both again, the angular portion of thisf
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