Ligation Of The Brachial Artery

In ligating the brachial artery. Heath strongly advises that the arm be held by an assistant in an abducted position with the hand supine and not allowed to rest on anything. The object of this is to avoid having the artery overlapped by the triceps being pushed up and thus becoming obscured. The incision is to be made in the line from the inner edge of the coracobrachialis to a point midway between the tips of the condyles. The deep fascia is to be opened and the inner edge of the biceps muscle is to be sought for, recognized, and held outward. The pulsation of the artery may indicate its position in the living; if not, it is to be sought for to the inner side of the edge of the biceps. The median nerve is not to be mistaken for it. It will lie either over its middle or to its inner side if low down and to its outer side if high up (Fig. 286). The ulnar nerve lies on the inner side of the artery as far as the middle of the arm, it then leaves the artery. Below the middle, if the search is made too far posteriorly, the ulnar nerve and basilic vein will be encountered. The ulnar nerve should not be seen, the basilic vein and median nerve - and above the middle of the arm the medial antebrachial (internal) cutaneous nerve - are to be displaced to the inner side.

Fig. 287.   Collateral circulation after ligation of the brachial artery at the bend of the elbow.

Fig. 287. - Collateral circulation after ligation of the brachial artery at the bend of the elbow.

The needle is to be passed from within outward. Care must be taken not to mistake a large superior or inferior profunda for the main trunk. A high division of the brachial may give two vessels of approximately equal size. Of course, in such a case both must be ligated.

Collateral Circulation

If the ligature is placed above the profunda (superior) branch, the anterior and posterior circumflex will anastomose with the profunda (superior) and superior ulnar collateral (inferior profunda) below. "If the ligature is placed between the profunda and superior ulnar collateral arteries, the profunda (superior) will anastomose below with the radial recurrent and posterior interosseous recurrent on the outer side and will also communicate with the inferior ulnar collateral (anastomotica magna) and superior ulnar collateral (inferior profunda) on the inside (Fig.287). If below the superior ulnar collateral (inferior profunda) then the profunda (superior) would anastomose with the radial and posterior interosseous recurrents on the outside, and the superior ulnar collateral (inferior profunda) with the inferior ulnar collateral (anastomotica magna) and the anterior and posterior ulnar recurrents.