By Karuna K. Chatterji
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Extra resources for A Handbook of Operative Surgery and Surgical Anatomy. With Chapters on Instruments
SURFACE MARKING Take a point (a) at the tip of the internal condyle (medial epicondyle) of the humérus and another (b) at the outer (lateral) side of the pisiform bone. Join these points by a line and divide it into three equal parts. Take a third point (c) at the junction of the upper third with the lower two-thirds of this line (a, b). Take a fourth point (d) at the middle point of the elbow, at a level of the head of the radius. Join the three points (d, c, b). This represents the line of the artery (see Fig.
ARTERIES. 39 incision falls in a line with the intercostal space. Feel for the subcostal groove and clear it by light touches of the knife and cutting the fibres of the external intercostal muscle. The artery will be seen lying between the vein above and the nerve below. Clear the nerve and the vein from the artery, pass the aneurysm needle from below lifting the artery up from its bed and apply proximal and distal ligatures. Comment :—(1) The above operation is the one generally indicated and commonly performed for ligation of the portion of the artery anterior to the angle of the rib.
At the Bend of the Elbow (Cubital Fossa) POSITION Same as for the previous operation. Flex and extend the elbow joint to determine the exact position of the biceps tendon and leave it in a slightly flexed position for the operation. OPERATION Make a slightly oblique incision two inches long through the skin and deep fascia along the inner (medial) edge of the biceps, the centre being on the crease of the elbow and its lower end pointing towards the thumb. Retract the superficial nerves and veins.