yo THE UPPER EXTREMITY 



course. As it approaches the medial epicondyle of the 

 humerus it joins the basilic vein. The median basilic vein 

 is the vessel commonly selected when the surgeon has 

 recourse to venesection. Therefore the relations of the vein 

 are of practical importance. The dissector should note the 

 following points regarding it : (i) that it crosses a thickened 

 band of deep fascia known as the lacertus fibrosus of the 

 biceps brachii ; (2) that the lacertus fibrosus separates it 

 from the brachial artery which the vein also crosses; (3) 

 that the volar branch of the medial cutaneous nerve of the 

 forearm usually passes behind it, although in many cases it 

 crosses in front of the vein. 



The basilic vein having received the median basilic vein 

 runs proximally, on the medial surface of the arm, in the 

 medial bicipital sulcus ; about half-way up the arm it pierces 

 the deep fascia, close to the spot at which the median 

 cutaneous nerve of the forearm emerges, and at the lower 

 border of the posterior wall of the axilla it becomes the 

 axillary vein. The arrangement of the veins of the forearm 

 is extremely variable. In many cases the median vein is 

 absent, and the cephalic and basilic are united, in the anti- 

 cubital region, by a large, oblique, anastomosing channel 

 which lies in the position of the median basilic vein and 

 appears to be the main continuation of the cephalic trunk, the 

 proximal part of the latter vessel being much reduced in size. 



Lymphoglandulae (Lymph Glands). If the superficial 

 fascia be searched upon the medial side of the limb, and 

 immediately above the elbow, one or two minute lymph 

 glands will be found in relation to the basilic vein. These 

 are the superficial cubital glands, and they are of interest to 

 dissectors as they are the first to enlarge and become painful 

 in cases of dissection-wound. 



Fascia Brachii (Brachial Fascia). The deep fascia should 

 now be cleaned by the removal of the fatty superficial layer. 

 It forms a continuous envelope around the arm, but at no 

 point does it show a great density or strength. Above, it is 

 continuous with the axillary fascia and the fascia covering the 

 pectoralis major and the deltoid. The tendons of these two 

 muscles are closely connected with it a certain proportion of 

 their tendinous fibres running directly into it. Below, it is 

 firmly fixed to the bony prominences around the elbow, and 

 in front it receives an accession of fibres from the tendon 



