By Karuna K. Chatterji
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Extra resources for A Handbook of Operative Surgery and Surgical Anatomy. With Chapters on Instruments
Take another point at the mid-point at the front of the bend of the elbow at a level of the head of the radius. The line joining these two points is the line of the artery. The last point represents its bifurcation into radial and ulnar arteries (see Fig. 13). A. In the Middle of the Arm POSITION Abduct arm to a right angle and supinate forearm. between the limb and the trunk. Place assistant opposite, other side of the arm. The arm rests on a small block under the olecranon. The middle of the upper arm should from any pressure from underneath to avoid pushing forwards.
Divide it carefully. The ulnar nerve is close to its inner side. Pass the needle from the ulnar side avoiding the nerve. COLLATERAL CIRCULATION After ligature of radial or ulnar arteries : Anterior (volar) and posterior (dorsal) interosseii with anterior (volar) carpal, posterior (dorsal) carpal and recurrent branch of the deep palmar (volar) arch. Comment :—(1) Do not cut. too deep. (2) Flex and extend, pronate and supinate to determine the various muscles. (3) The direction of the fibres of the brachio-radialis and pronator radii teres (pronator teres) are vertical and oblique respectively.
3) The artery has complicated relations with important structures. I t must be identified from its own numerous branches and from the internal carotid which has no branches in the neck. (4) The branches of the external carotid of either side anastomose so freely t h a t the ligation of one vessel does not materially affect the haemorrhage in the regions supplied by these vessels. COLLATERAL CIRCULATION The circulation is re-established by the free communications between (a) most of the large branches of the artery (facial, lingual, superior thyreoid, occipital) and the corresponding arteries of the opposite side ; (b) by the anastomosis of its branches with those of the internal carotid ; (c) of the occipital with branches of the subclavian.
A Handbook of Operative Surgery and Surgical Anatomy. With Chapters on Instruments by Karuna K. Chatterji