THE BRACHIAL KEGION. 143 



by the main vessel and its branches, determines the con- 

 tents of the flaps in amputation of the upper arm. 



Relations of Bracliial Artery (above bend of elbow). 

 Its course is indicated by a line drawn from the junction 

 of the anterior with the posterior two-thirds of the axilla, 

 to the centre of the bend of the elbow. It is accompanied 

 by venae comites, which frequently interlace and conceal 

 the vessel when cut down upon. In front of the vessel 

 is the integument and fasciae and the median nerve; ex- 

 ternally, median nerve (in upper half), coraco-brachialis, 

 and biceps ; internally, internal cutaneous and ulnar 

 nerves, and in lower half the median nerve ; posteriorly, 

 lie the brachialis anticus, coraco-brachialis, musculo- 

 spiral nerve, and superior profunda vessels, separating 

 the middle and long heads of the triceps. 



Ligature in the upper third is performed by making an 

 incision about two inches in length along the inner bor- 

 der of the coraco-brachialis muscle ; the subcutaneous 

 tissue and aponeurosis are to be divided, taking care to 

 avoid the basilic vein ; then the internal cutaneous and 

 ulnar nerves will be found on the inner side of the artery, 

 the median externally, and a number of venae comites 

 superficial to, and on each side of it. The needle should 

 be applied from within outwards. Occasionally two ves- 

 sels are found lying parallel to each other, or placed one 

 over the other, the posterior lying very deep, the result 

 of a high division ; under such circumstances it is obvi- 

 ous that it must be determined by pressure whether one 

 or both communicate with the aneurism or wound. 



In the middle third the vessel is not so easy to tie as 

 might be imagined from its superficial position ; it is 

 beneath a very dense part of the fascia, often overlapped 

 by the biceps, and very movable beneath the integument. 



