Ligation of the third part of the axillary is done
through an incision two inches in length made in the
course of the vessel, and about the junction of the anter-
ior and middle thirds of the antero-posterior fold of the
axilla. The ‘skin and superficial fascia having been
incised, the deep fascia is exposed and carefully divided
and the deep landmarks sought for. These are the
relations to the vessel of the coraco-brachialis muscle and
the median nerve which lie to its outer side, and of the
axillary vein and ulnar nerve that lie to the inner side of
the artery. Should a nerve present itself in the incision it
may be the median or the ulnar and gentle traction will
tell which it be, for, it the median, it will be felt by the
finger placed on the inner side of the biceps tendon at the
bend of the elbow ; if the ulnar, by the finger behind the
internal condyle. Should it be the median nerve then the
vessel must be sought for on the inner side of the nerve ;
if the ulnar, the artery will be found external to it, while
if the vein present itself, the artery will be found on the
outerside of it also. It must not be forgotten that the
median nerve occasionally lies over the vessel in this
situation, and the pulsations of the artery being conveyed
to the nerve may cause it to simulate the vessel. When
the identity of the artery has been established it should be


48 Anatomy Applied to Medicine and Surgery.
