14:4 SURGICAL ANATOMY OF 



It is reached by an incision along the inner border of 

 this muscle, the forearm being slightly flexed so as to 

 relax the biceps. The median nerve is usually first met 

 with, crossing the vessel ; this should be drawn inwards 

 and the biceps outwards, and the venae comites carefully 

 separated from the trunk before a ligature is applied. In 

 this instance, as in several others, it is advisable to make 

 the incision slightly oblique to the real course of the 

 vessel, as room is gained, and also a better view of any 

 deviation from its natural course. The inferior profunda, 

 if large, or the ulnar nerve, may sometimes be mistaken 

 for this vessel. 



Branches of the Brachial Artery. The superior pro- 

 fnnda is given off generally opposite the lower border of 

 the teres major, and accompanies the musculo-spiral 

 nerve; the nutritious artery enters the nutrient canal 

 near the insertion of the coraco-brachialis, and passes 

 downwards towards the elbow-joint; the inferior pro- 

 funda accompanies the ulnar nerve ; the anastomotica 

 magna arises on the inner side, about two inches above 

 the elbow-joint, and lies between the brachialis anticus 

 and median nerve, crossing the latter, and finally divides 

 into two large branches. In applying a ligature to the 

 lower portion of the main trunk, the position of this 

 vessel is of importance, as it is the chief means of carry- 

 ing on the collateral circulation. 



Collateral Circulation. After ligature above the origin 

 of the profunda superior, the posterior circumflex and 

 subscapular, anastomosing with the ascending branches 

 of the profunda, carry on the circulation ; if below, the 

 superior and inferior profunda, inosculating with the 

 recurrent branches of the radial, ulnar, and interosseous, 

 would maintain it. 



