The practice of surgery . In consideration of the possibility of trouble with the CANCER OF THE BREAST 519 urm Murphy ^ advocates certain muscle-plastic procedures which areinteresting. He points out that undesirable results of removal of thebreast as commonly done are: (1) Fixation of the arm to the chest, withmore or less limitation of motion; (2) venous stasis in the arm and fore-arm with edema; (3) pseudoelephantiasis; (4) neuralgia in the arm andforearm; (5) sensitive retracting scars. In order to forestall these cal-amities Murphy advises dressing the arm at a right angle to the chest an
The practice of surgery . In consideration of the possibility of trouble with the CANCER OF THE BREAST 519 urm Murphy ^ advocates certain muscle-plastic procedures which areinteresting. He points out that undesirable results of removal of thebreast as commonly done are: (1) Fixation of the arm to the chest, withmore or less limitation of motion; (2) venous stasis in the arm and fore-arm with edema; (3) pseudoelephantiasis; (4) neuralgia in the arm andforearm; (5) sensitive retracting scars. In order to forestall these cal-amities Murphy advises dressing the arm at a right angle to the chest andsupporting it in a plaster splint during the early days of convalescence,and the interposing of muscle slips between the axillary vessels and theaxillary skin. His arguments are ingenious and suggestive, and hismethods appear feasible. He uses long and broad slips from the pector-alis major or latissimus dorsi. He justifies his use of the pectoralismajor by asserting that its entire removal with the breast is needless,. Fig. 331.—Warrens operation for amputation of the breast—step 5. as the aponeurosis and not the muscle carries the lymphatics in whichmetastases occur. Most operators, while agreeing in part with Murphyin this contention, will protest that no man may say whether or not thepectoralis major muscle itself is involved in the disease. The use of thelatissimus dorsi, however, seems free from this objection, and the ap-plication of the plaster bandage with the arm held out from the sidepromises much. On the other hand, the disabilities rehearsed by Murphyare not so common as he might lead us to suppose. Careful surgeonsendeavor to fill in snugly the axillary gap after the dissection, and excel-lent function of the arm under the old methods is the rule. I find that,by the careful obliteration of dead spaces, by draining the axilla fortwenty-four hours, by padding abundantly the axilla so as to hold the 1 J. B. Murphy, Axillary and Pectoral Cicatrices Following the
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
