274 



APPLIED ANATOMY. 



The pro/ 'undo, is given off just below the lower edge of the posterior fold of the 

 axilla (teres major). It accompanies the radial (musculospiral) nerve around the 

 arm to its outer side; it sends one branch, the radial collateral, to the front of the 



Median nerve 

 Biceps muscle 



Ulnar nerve 



Brachial artery 



J 



. Superior profunda (A. profunda 

 brachii) 



-Brachial artery 



Inferior profunda (collateralis 

 ulnaris superior) 



Anastomotica magna (collate- 

 "ralis ulnaris inferior) 



FIG. 286. Ligation of the brachial artery in the middle of the arm showing the median nerve lying on the artery 



and the ulnar nerve to its inner side. 



elbow and the middle collateral behind it. The superior ulnar collateral artery 

 (inferior profunda) comes off about opposite the insertion of the coracobrachialis 



muscle. It is much smaller than the pro- 

 funda and with the ulnar nerve pierces the 

 internal intermuscular septum. The nutri- 

 ent artery comes off close to the origin of 

 the superior ulnar collateral (inferior pro- 

 funda) or is a branch of it. It passes down- 

 ward in the bone in a direction toward the 

 elbow-joint. The inferior ulnar collateral 

 (anastomotica magna) is given off 5 cm. 

 (2 in.) above the elbow and passes inward 

 over the brachialis anticus to divide into 

 two branches, one going down in front and 

 the other behind the elbow. 



Ligation of the Brachial Artery. 

 In ligating the brachial artery, Heath 

 strongly advises that the arm be held by an 

 assistant in an abducted position with the 

 hand supine and not allowed to rest on any- 

 thing. The object of this is to avoid hav- 

 ing the artery overlapped by the triceps be- 

 ing pushed up and thus becoming obscured. 

 The incision is to be made in the line 

 from the inner edge of the coracobrachialis 

 to a point midway between the tips of the 

 condyles. The deep fascia is to be opened 

 and the inner edge of the biceps muscle 

 is to be sought for, recognized, and held 

 outward. The pulsation of the artery may 

 indicate its position in the living; if not, it 

 is to be sought for to the inner side of the 

 edge of the biceps. The median nerve is 

 not to be mistaken for it. It will lie either 



over its middle or to its inner side if low down and to its outer side if high up (Fig. 286). 

 The ulnar nerve lies on the inner side of the artery as far as the middle of the 



Radial recurrent 

 Ulnar recurrent 



Interosseous recurrent 



Posterior interosseous 

 Anterior interosseous 



Radial artery 

 -Ulnar artery 



FlG. 287. Collateral circulation after ligation of the 

 brachial artery at the bend of the elbow. 



