THE AXILLA. 131 



circumflex vessels and nerve, tendons of latissimus dorsi, 

 teres major, and teres minor; the internal flap, the sub- 

 scapularis, long head of biceps, coraco-brachialis, an- 

 terior fibres of deltoid, pectoralis major, axillary vessels 

 and nerves, and integuments. 



In the oval method the articulation is exposed, by 

 making an incision about two inches long down to the 

 bone, immediately below the acromion process, and a 

 curved incision from this point on either side, each in- 

 closing a semilunar flap, to the anterior and posterior 

 folds of the axilla. Disarticulation is next effected. 



The most anatomical as well as the best method of ex- 

 cising the head of the bone, is by exposing it by a ver- 

 tical incision extending from a point just external to the 

 tip of the coracoid process, corresponding to the position 

 of the bicipital groove; an incision which has the ad- 

 vantage of avoiding the circumflex vessels and nerve. 

 The long tendon of the biceps should be preserved, if 

 possible, to assist in the movements of the resulting 

 false joint. 



SUKGICAL ANATOMY OF THE AXILLA. 



Surface Markings and External Form. When the arm 

 lies against the wall of the chest the area of the axillary 

 space becomes confined, and for anatomical considerations 

 ceases to exist; also when extended beyond a right 

 angle, the head of the humerus projects into the space 

 and obliterates its fold. But when the arm is raised to 

 about an angle of 45, and the muscles contract, the 

 depth of the fold of the axilla is most marked. 



The boundaries of the axilla, which are seen beneath 

 the skin, are, anteriorly, the lower margin of the pec- 



