File:The breast- its anomalies, its diseases, and their treatment (1917) (14570416339).jpg

Identifier: breastitsanomali00deav (find matches)
Title: The breast: its anomalies, its diseases, and their treatment
Year: 1917 (1910s)
Authors: Deaver, John B. (John Blair), 1855-1931
Subjects: Breast Breast X-rays Breast Diseases Breast Neoplasms Radiotherapy
Publisher: Philadelphia, P. Blakiston's Son & Co
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons

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act inward as soon as their respective tendons are severed. This at once uncovers the axilla and makes its subsequent thorough dissection easy. Thecosto-coracoid membrane is now opened and largely sacrificed, which gives ready access to the sub-clavicular fat at the apex of the axilla—-in the space of Mohrenheim. In removing a part of the costo-coracoid membrane the cephalic vein at the upper and outer aspect of the wound must not be wounded.There is also in the fascia a branch of the acromiothoracic artery which, with its accompanying veinshould be clamped and tied. A nerve supplying the pectoral muscle may as well be sacrificed now, asit necessarily must be later on when the muscles are removed. The dissection is done at the apex of the axilla and must be most carefully conducted lest injury bedone to either the axillary vein or the acromio-thoracic artery. It should be from above downward,though this is perhaps somewhat more difiicult than making the dissection from below upward.
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Fig. 227,—Illustrating the Rodman operation for mammary carcinoma. Division of the pectoralisminor muscle at its insertion. in the removal of the fat and fascia in theupper third of the axilla, the finger, covered by severalthicknesses of gauze will be all that is necessary. Instruments are rather dangerous, unless used mostcautiously. Moreover, they are unnecessary. I now carefully make an incision through the fascia to the outer side of the axillary vessels simplyto start the dissection from within outward. This is made to the extent of the lower two-thirds of the axillaand not in the upper third where it is dangerous to cut. I continue the dissection largely with gauze,but Alliss or Mayos blunt dissectors may be used freely and are most helpful. Occasionally a cut withscissors or a sharp knife facilitates the dissection. ... As the sheath and fat are removed from thevessels we come down upon the acromial, long and alar thoracic branches, and the subscapular branchof the axillary

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