By Karuna K. Chatterji
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Extra info for A Handbook of Operative Surgery and Surgical Anatomy. With Chapters on Instruments
Now, divide the deep fascia taking care not to injure the external jugular vein which lies superficial to it. Retract the sterno-mastoid forwards and define the scalenus anticus (anterior) at the carotid tubercle. Displace the carotid sheath inwards. The artery can be felt immediately below the tubercle. Pass the needle from without inwards, keeping clear of the veins. Comment :—(1) The artery is deep in situation and there is a fair amount of venous oozing. (2) Relax the muscles of the neck in order to get as good a view as possible.
OPERATION Determine the position of the cricoid cartilage, make an incision two inches long dividing the skin and the platysma in the line of the artery keeping its centre on a level of this (see Fig. 23A). This exposes the deep fascia. Divide it along the anterior margin of t h e sterno-mastoid (sterno-cleido-mastoideus). Define the edge of the muscle and follow it till the omo-hyoid muscle is felt. Demonstrate the angle of the meeting of these two muscles. Retract the sternomastoid outw r ards (lateralwards) and the omo-hyoid downwards.
Comment :—(1) Deepen incision cautiously as the artery is liable to be cut across. (2) Do not open the tendon sheaths. LIGATION OF T H E ULNAR ARTERY POSITION As for the radial artery. SURFACE MARKING Take a point (a) at the tip of the internal condyle (medial epicondyle) of the humérus and another (b) at the outer (lateral) side of the pisiform bone. Join these points by a line and divide it into three equal parts. Take a third point (c) at the junction of the upper third with the lower two-thirds of this line (a, b).