264 The Brachial Artery 



superficial fascia, and the deep fascia with its reinforcement from the 

 inner side of the biceps-tendon the bicipital fascia. The floor of the 

 space is formed by the brachialis anticus and by a little of the supi- 

 nator brevis. In the superficial fascia are the M-like arrangement of the 

 veins (p. 237) and many branches of the internal and musculo-cutaneous 

 nerves. 



Contents. The most prominent object in the space is the tendon 

 of the biceps ; and, as the brachial artery has lain on the inner side 

 of biceps all the way down the arm, it lies close to the inner side of 

 its tendon in this fossa. On either side of the artery is a small com- 

 panion vein, and well to the inner side is the median nerve. 



In the fossa, at the level of the neck of the radius, the artery divides 

 into the radial and ulnar, which, consequently, begin their course 

 somewhat superficially. The radial artery leaves the space over the 

 insertion of the pronator teres, but the ulnar artery quickly descends 

 beneath the origin of that muscle and beneath the median nerve in its 

 oblique course to the inner border of the fore-arm. The radial recur- 

 rent artery is seen ascending to the crevice between the brachialis 

 anticus and the supinator longus. Under cover of the supinator 

 longus, and, therefore, scarcely within the space, is the radial nerve. 

 In a thin subject the posterior interosseous nerve may also be found 

 coining from the division of the musculo-spiral, but to see so much 

 the supinator longus will have to be pulled considerably outwards. 



Xiig-ation of the brachial is the proper treatment for recurrent 

 haemorrhage after a deep wound of the palm, for it is impracticable to 

 search through the layers of nerves, tendons, and lumbricals to find the 

 bleeding point. It is also resorted to for aneurysms high in the fore- 

 arm. 



Operation. The patient is lying on his back with the arm abducted, 

 rotated outwards, and resting on a firm pillow. An incision is then 

 made for 2\ in. along the groove upon the inner side of the biceps. 

 In dividing the superficial fascia, the basilic vein, if seen, must be drawn 

 to one side. The deep fascia having been divided on a director, the 

 inner border of the biceps is looked for and drawn outwards. The 

 median nerve is probably lying over the arterial sheath, but if the 

 operation be performed high in the course of the brachial the IHTVI- 

 will be to the outer side ; if in the lower part, to the inner side. Heed 

 must be given not to tie the nerve instead of artery, nor to include it 

 with the artery in the ligature. A loose sheath is opened, and the 

 needle passed round the arteiy (the venae comites being avoided) from 

 the side of the median nerve, whichever that may be. 



If ligation be required at the be ml of the cllnw, the vessel is found 

 by making a 2-inch incision along the inner side of the biceps tendon. 



The lower limit of the incision reaches to the level of the internal 

 condyle, and will probably l>c just above and to the outer side of the 

 median-basilic vein. The bicipital fascia is divided on a director, and 



