282 SURGICAL APPLIED ANATOMY. [Chap. xv. 



and the tendons of the flexor sublimis and flexor carpi 

 radialis. The tendons of the flexor profundus and 

 flexor longus pollicis are usually cut short close to the 

 bones. 



Amputation of the thumb at the carpo-meta- 

 carpal joint by flaps. In the palmar flap would be 

 cut the abductor, the short and long flexor, the op- 

 ponens, and adductor pollicis. The extensores ossis 

 and brevis would be cut short in the posterior angle 

 of the flap. The extensor longus and a considerable 

 portion of the abductor indicis would be found in the 

 dorsal flap. The vessels divided would be the two 

 dorsal arteries of the thumb and the princeps pollicis. 

 There is great danger, in this operation, of wounding 

 the radialis iadicis and the radial artery itself where it 

 begins to dip into the palm. 



Nerve supply of the upper limb. In the 

 diagnosis of nerve injuries of the upper limb it is im- 

 portant to know from which spinal nerves the various 

 muscles are supplied. Dr. Herringham has dealt fully 

 with this subject in his account of the minute anatomy 

 of the brachial plexus. The following is his account 

 of the usual composition of the chief nerves, and of 

 the usual supply of the chief muscles. (The figures 

 indicate the fifth, sixth, seventh, and eighth cervical 

 nerves, and the first dorsal nerve.) 



Nerves. Nerve of Bell, 5, 6, 7 ; suprascapular, 5 

 or 5, 6 ; external cutaneous, 5, 6, 7 ; internal 

 cutaneous, 1 or 8, 1 ; nerve of Wrisberg, 1 ; cir- 

 cumflex, 5, 6 ; median, 6, 7, 8, 1 ; ulnar, 8, 9 ; mus- 

 culo-spiral, 6, 7, 8, or 5, 6, 7, 8. 



Muscles, 3, 4, 5, Lev. anguli scap. ; 5, rhomboids ; 

 5 or 5, 6, biceps, brachialis ant., supra- and infra- 

 spinatus, teres minor ; 5, 6, deltoid, subscapularis ; 0, 

 teres major, pronator teres, flexor carpi rad., supin. 

 longus and brevis, superficial thenar muscles ; 5, 6, 7, 

 serratus magnus ; 6 or 7, extensores carpi rad. ; 7, 



