48 Anatomy Applied to Medicine and Surgery. 



ligated by passing the needle from the ulnar toward the 

 radial side. In ligating this part of the axillary artery it 

 will be well to bear in mind the occasional existence of a 

 muscular slip stretching across the artery from the latiss. 

 dorsi to the biceps or to the coraco-brachialis, since the 

 presence of muscular tissue might confuse the operator, 

 but the direction of the fibres and the width of the band 

 would distinguish it. Again, it is advisable in ligating 

 the axillary to remember that in 10 per cent, of cases 

 there are two large trunks, one of which forms the 

 brachial while the other is for the origin of the circumflex, 

 thoracics, etc. In these cases the nerves would surround 

 the latter branch and so be useless as guides to the trunk 

 to be ligated. The collateral circulation after ligature 

 of the axillary artery above the origin of the subscapular 

 and circumflex branches consists in the anastomoses of 

 the posterior scapular and suprascapular from the sub- 

 clavian above with the subscapular and circumflex from 

 the axillary below and of the thoracic branches of the 

 intercostals with the subscapular. If ligated below the 

 circumflex the circulation would be carried on by the 

 anastomoses of the circumflex and super, profunda arteries 

 as well as by new channels from the subscapular above to 

 to the super, profunda below. To expose the subscapular 

 artery an incision should be made a little above the anter- 

 ior border of the latiss. dorsi, and the artery would be 

 found, as already mentioned, about an inch above that 

 border having the lower subscapular nerve below, the 

 long subscapular above, and the subscapular vein in 

 front. To expose the circumflex artery and nerve, make 

 an incision along the posterior border of the deltoid with 

 its centre corresponding to where this border crosses the 

 axillary border of the scapula. When the muscle is 

 exposed its posterior border is drawn outward, and the 



