Ligation of Radial Artery 275 



THE ARTERIES OF THE FORE-ARM 



The radial artery comes from the bifurcation of the brachial 

 opposite the neck of the radius, and, though smaller than the ulnar, is, 

 by its direction, the direct continuation of the parent trunk. 



Its course in the fore-ami may be markedly a line from the middle 

 of the bend of the elbow to the middle of the hollow between the 

 styloid process of the radius and the tendon of the flexor carpi radialis. 

 From this spot it winds round to the back of the wrist, and so into 

 the palm of the hand, to form the deep palmar arch. 



Relations in the fore-arm. It is covered by skin, superficial and 

 deep fasciae, and is overlapped by the anterior border of the supinator 

 longus. It rests upon the tendon of the biceps, the supinator brevis, 

 the pronator teres, the radial origin of the flexor sublimis digitorum, the 

 flexor longus pollicis, the pronator quadratus, and the radius. 



To its outer side are the supinator longus, and, in the middle third, 

 the radial nerve. 



Along its inner side is the pronator teres, and, after that, the flexor 

 carpi radialis. On either side runs a companion vein. 



Branches in the fore-arm. The radial recurrent ascends on the 

 supinator brevis to the interval between the supinator longus and the 

 brachialis anticus, where it lies against the musculo-spiral nerve, and 

 anastomoses with the superior profunda. This is the only artery at 

 the elbow which does not communicate with the anastomotica magna ; 

 the explanation being that these two branches are separated by the 

 large mass of the brachialis anticus. 



Muscular branches are given off freely and irregularly. 



The superficialis volee is given off close above the wrist, and runs 

 over the anterior annular ligament, or through or over the root of the 

 muscles of the ball of the thumb. Sometimes it joins in the formation 

 of the superficial palmar arch, but it often ends in the muscles of the 

 thumb. When this artery is large, the finger applied at the lower 

 part of the front of the wrist detects a ' double pulse.' 



The anterior carpal runs inwards beneath the flexor tendons to 

 join a corresponding branch of the ulnar artery ; it lies in front of the 

 lower border of the pronator quadratus. 



Ligation in the upper part of the fore-arm. An incision of two 

 and a-half inches is made in the line of the artery through the skin 

 and the superficial and deep fasciae, when the longitudinal muscular 

 fibres of the supinator longus are exposed. The edge of this muscle 

 may, perhaps, be a little to the inner side of the incision, but when 

 the muscle is small the connective tissue over the vessel is at once 

 exposed. The border of the muscle is gently drawn outwards, and, 

 by working with the director through the bed of connective tissue, 

 the artery, with a companion vein on either side, is found lying 



