File:The breast- its anomalies, its diseases, and their treatment (1917) (14570398120).jpg

Identifier: breastitsanomali00deav (find matches)
Title: The breast: its anomalies, its diseases, and their treatment
Year: 1917 (1910s)
Authors: Deaver, John B. (John Blair), 1855-1931
Subjects: Breast Breast X-rays Breast Diseases Breast Neoplasms Radiotherapy
Publisher: Philadelphia, P. Blakiston's Son & Co
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons

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andthe axillary contents. The usual radical amputation is then performed. This incision allows of a verywide removal of skin surface. The defect is filled in with an auto-plastic flap lifted from the dorsalregion between the posterior axillary margin and the vertebral border of the scapula. The pedicle of theflap is at the extreme upper end of the axiUary incision so that the transplanted flap covers the skin defectin the axillary cavity and the linear scars meet, the one corresponding to the anterior portion and theother to the posterior portion of the axilla. As first devised the operation was unsatisfactory becausethe flap suffered necrosis for fully one-third of its extent in the majority of cases; to remedy this defectin technic Tansini, in a second paper, gives very explicit directions for the formation of the flap. He observed that the subscapular artery and its dorsal scapular branch were theimportant arteries given to this flap. The arterial ramus leads toward the surface be-
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FiG. 250.—Showing the results of the Tansini operation. (Tansini.) tween the two teres muscles and branches extend to the latissmus dorsi musclesand to the cuticle. To insure vitality of the flap he advises, therefore, to include in itthe latissimus dorsi muscle and perhaps also the teres major. This procedure not onlyinsures its vitality but provides a flap more perfect in reparation for the removed axillarystructures. The pedicle should have a diameter of 6 or 7 cm. with its center correspond-ing to a point about 3 cm. from the posterior axillary line and about 5 cm. from thespine of the scapula. This insures inclusion of the blood supply. The wound isclosed by slipping the skin, made flexible by two linear incisions above and below.Complete closure is possible, as a rule. Without doubt by this ingenious method the skin flap from the back is easily carriedin front of the pectoral incision and perfectly replaces the lost skin, while the dorsalwound is closed with comparative ease.

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