2QO 



APPLIED ANATOMY. 



over the bicipital fascia, which separates it from the brachial artery which lies directly 

 beneath. The median basilic vein (or cephalic when more prominent) is usually 

 chosen for purposes of saline infusion. It lies to the inner side of the biceps tendon 

 and no important structures are liable to be wounded. The terminal filaments of 

 the musculocutaneous nerve pass under the median cephalic vein and are not liable 

 to be wounded. If the median basilic is chosen for infusion or venesection care must 

 be taken not to cut through the bicipital fascia, otherwise a wound of the brachial 

 artery may be produced which may result in the formation of a varicose aneurism or 

 aneurismal varix. 



When these veins are .wounded the bleeding may be very free. Not only are 

 the superficial parts drained but likewise the deep parts through the communication 

 with the median. We saw one case in which death nearly resulted from such a 

 wound made by a piece of tin. When saline infusion is practised the vein selected 

 is made visible by compressing it above. It is then cut directly down upon and 

 isolated, and the cannula inserted. 



BRACHIAL ARTERY. 

 At the bend of the elbow the artery lies to the inner side of the biceps tendon. 



It is beneath the bicipital or semilunar fascia, 

 felt opposite the crease. In the lower third 

 of the arm the median nerve lies close 

 to the artery, but as the bend of the elbow 

 is reached it diverges and becomes sepa- 

 rated from it by the coronoid head of the 

 pronator radii teres muscle. Superficial to 

 the deep fascia is the median basilic vein, 

 crossed at its upper portion by the cuta- 

 neous antebrachii medialis (internal cuta- 



The upper edge of this fascia can be 



Internal condyle 



Median nerve 



Venae comites 



Brachial artery 



Biceps tendon 



FIG. 301. Ligation of the brachial artery at the bend 

 of the (left) elbow. 



Superior profunda (A. profunda 

 brachii) 



Brachial artery 



Inferior profunda (collateralis 

 ulnaris superior) 



Anastomotica magna (collate- 

 ralis ulnaris inferior) 



Radial recurrent 

 Ulnar recurrent 



Jnterosseous recurrent 

 r interosseous 

 interosseous 

 irtery 



Ulnar artery 



FIG. 302. Collateral circulation after ligation of the 

 brachial artery at the bend of the elbow. 



neous) nerve. The bifurcation of the brachial artery occurs opposite the neck of the 

 radius, which is approximately a finger's breadth, or about 2 cm., below the crease of 

 the elbow. 



Ligation of the Brachial Artery at the Bend of the Elbow. The inci- 

 sion is laid along the inner edge of the biceps tendon. The median basilic vein is 

 usually more prominent than the median cephalic and can be seen obliquely crossing 



