. The breast: its anomalies, its diseases, and their treatment . uelyfrom above downward and outward to the outer quadrant of the breast. The incision is, of course,carried through the skin and fascia to the underlying muscular structures, exposing the fibres of thepectoralis major converging well to its tendinous insertion in the humerus. At the lower point of this incision where it curves along the under border of the pectoralis majormuscle, the index-finger of one hand is now shoved up underneath the pectoralis major and brought outagain at its upper border so that the entire pectoralis maj
. The breast: its anomalies, its diseases, and their treatment . uelyfrom above downward and outward to the outer quadrant of the breast. The incision is, of course,carried through the skin and fascia to the underlying muscular structures, exposing the fibres of thepectoralis major converging well to its tendinous insertion in the humerus. At the lower point of this incision where it curves along the under border of the pectoralis majormuscle, the index-finger of one hand is now shoved up underneath the pectoralis major and brought outagain at its upper border so that the entire pectoralis major muscle is thus hooked on the index-finger andby blunt dissection separated out to its tendinous insertion. With the tendon of the pectoralis musclethus lifted up it is divided by the scalpel very close to its insertion in the humerus. The pectoralisminor muscle is then exposed by blunt dissection by the finger and is isolated as was the pectoralis is also divided close to its attachment to the coracoid process of scapula. The wound is held apart by. Fig. 259.—Jacksons incision. retractors and the axillary space is now widely exposed to view. This exposure, as a rule, occurs withoutencountering any bleeding vessels which will require clamp or ligature. To the outer side of the axillary vein and parallel to it an incision is made of the fascia which surroundsthe vessels. The fascia is stripped off by blunt dissection and gauze supplemented by an occasionalsnipping with scissors; the operator works steadily from without inward cleaning fascia glands, etc., ashe goes. In this way the axillary vein and artery are isolated and the branches supplying the axillaand leading to the chest are made plainly apparent. These vessels should at once be ligated and clamped. . Beginning thus at the apex and outerborder of the axilla, fascia and glands are completely cleared by gauze and scissors dissection workingfrom the vessels inward to the chest. As this cleaning of the deep fas
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectbreast, bookyear1917
