

Axillary Artery 245 



latissimus dorsi ; and on the inner side by the six upper ribs, the 

 intercostal muscles, and the serratus magnus. The base is covered 

 in by the deep fascia, which extends from over the pectoralis major 

 to the latissimus dorsi, and on to the chest-wall. 



The space contains the axillary vessels and their branches ; the 

 brachial plexus and most of its branches ; the intercosto-humeral nerve ; 

 fat, and many lymphatic glands. The anterior and posterior folds 

 meet at the bicipital groove, the coraco-brachialis and biceps filling this 

 crevice. 



The most important of the contents lie along the outer side of the 

 space ; against the inner wall there are merely the thoracic branches 

 of the artery and vein, the intercosto-humeral nerve, the nerve of Bell, 

 and lymphatics. Thus the surgeon may proceed with comparative 

 freedom in the removal of malignant glands or other tumours from 

 the thoracic side of the space, but along the humeral region he must 

 act with much deliberation. 



To open an axillary abscess, a small incision should be made 

 with a scalpel through the deep fascia of the floor of the space, the 

 opening being subsequently enlarged by the director and dressing- 

 forceps, after the manner of Hilton. I have seen a paralysed serratus 

 magnus in a man whose axillary abscess had been opened by a bold 

 plunge of a surgeon's knife, the nerve of Bell having been severed. If 

 the ' plunge ' had been made into the outer part of the space instead 

 of into the inner, the vessels would probably have been wounded. 



The axillary artery continues the subclavian from the outer 

 border of the first rib, through the apex and the outer part of the 

 space, and down to the lower border of the tendon of the teres major, 

 where the name changes to brachial. It lies to the inner side of the 

 shoulder-joint and the humerus, being separated from the former by 

 the insertion of the subscapularis. The narrow part of the pectoralis 

 minor crosses it in the neighbourhood of the coracoid process, and 

 divides it into three parts. 



The first part of the artery extends from the first rib to the lesser 

 pectoral a very short distance. The second part is shorter still, 

 being the mere width of the pectoralis minor just before its insertion. 

 The third part is much longer, reaching from the lower border of 

 the lesser pectoral to the lower border of the tendon of the teres 

 major. 



To mark the course of the axillary artery, the arm should be 

 abducted and slightly rolled outwards, and a line drawn from the 

 middle of the clavicle to the groove on the inner side of the biceps. 



Relations. The surgeon takes a more liberal view of the relations 

 of an artery than is allowed to the student. The division of the artery 

 into three parts concerns him only to this extent : that the second 

 part, being under cover of both pectoral muscles, is inaccessible for a 

 ligature ; that the first part may be reached in the infra-clavicular 



