6 CLINICAL APPLIED ANATOMY. 



In opening an axillary abscess, the line of the incision is 

 usually made vertically along the inner wall, and half-way between 

 the anterior and the posterior folds of the axilla. In this way the 

 chief blood-vessels will be avoided, namely the axillary, lying 

 along the outer wall, the long thoracic, under cover of the 

 anterior fold, and the subscapular, close to the posterior fold. In 

 addition, this incision will give the best drainage when the 

 patient is sitting up, a position which will be frequently assumed 

 after the evacuation of the pus. 



Healing may be delayed unless the arm is kept at rest by the 

 side, and sometimes the cicatricial tissue formed may by its con- 

 traction afterwards limit the perfect movements of the scapula 

 over the thoracic wall, and even interfere with those of the 

 shoulder- joint itself. 



Inguinal Abscess, or Bubo. Suppurative lymphadenitis is 

 the usual cause of this form of abscess. The lymphatic glands 

 lying above Poupart's ligament are frequently infected in 

 gonorrhoea, and an abscess often has to be dealt with. As the 

 glands lie superficial to the aponeurosis of the external oblique 

 muscle, there is not much difficulty for the pus to find its way to 

 the surface ; hence burrowing is not common. 



An incision to evacuate the pus may be made either obliquely, 

 parallel with Poupart's ligament, or vertically over the summit of 

 the swelling. Two anatomical objections may be urged against 

 the former : every movement of the thigh will tend to draw the 

 lower edge of the incision away from the upper, and thus retard 

 healing, and there will be a tendency for the inferior part of the 

 wound to form a trough or pocket in which pus may collect. To 

 the vertical incision, especially if made freely, neither of these 

 objections can be brought. It is, however, best to make an oblique 

 incision over the whole length of the swelling, and to dissect out 

 the offending glands and the bulk of the surrounding inflamed 

 tissues by a planned operation under a general anaesthetic. 



Psoas Abscess. An abscess within the fascial sheath of the 

 psoas muscle is nearly always the outcome of a tuberculous 

 deposit in the bodies of the lower dorsal or the lumbar vertebrae. 



