The axilla is filled with blood vessels, lymph vessels, lymph glands, nerves, and masses of fat.
To Raise the Artery.—Make an incision on the linear guide. After the skin is passed through there is a large quantity of fascia, lymph glands, and lymph vessels, which must be carefully dissected through, and at the same time the axillary vein will be discovered. This vein, for the present, should not be loosened from the surrounding tissues. Dissect down to the upper side of the vein, and the common sheath of fascia surrounding the artery and nerves will be seen. By carefully tearing this the length of the incision, the brachial plexus of nerves now is exposed. Now by gently pushing the nerves apart with the handle of the scalpel, the artery will be seen. With a hook loosen the artery from the surrounding tissues and raise to the surface.
If it is desired to draw blood, now proceed to raise the vein to the surface. Open the vein and insert a drainage tube, which should be long enough to reach through the entire length of the axillary and subclavian veins, because they have valves along their entire course nearly to the bifurcation of the innominate.
Inject a few ounces of fluid toward the hand as the axillary is above the point of collateral circulation. Then reverse the tube and inject toward the heart, until a sufficient amount of fluid has been injected.
Relation of Artery, Vein and Nerve.—The vein is quite superficial, just below it and to the upper part of the incision is the brachial plexus of nerves, which surrounds the artery.
How to Locate, Raise, and Inject the Brachial Artery.
—The brachial artery is located in the upper arm and extends from the inferior margin of the muscle pectoralis major, or from the shoulder to the elbow. It is one of the most popular arteries known to the embalmer, and is now used, perhaps, more than all others combined.
The anatomy of this vessel is simple, yet, when we take into consideration all the numerous anomalies or irregularities that surround its use to us as embalmers, we feel the necessity of making the description very thorough and complete, in order to raise it under all the various difficulties that attend its use.
The brachial artery has its several branches, the most prominent of which are the artery profunda brachii (superior profunda artery) and the artery collateralis ulnaris superior (inferior profunda artery) and the artery collateralis inferior (anastomotica magna artery).
For the sake of a more correct description we divide the artery into thirds, viz: the upper, middle and lower thirds. The upper third begins at the extreme upper part of the arm and extends one third of the way to the elbow, the middle and lower thirds occupy the remainder of the artery. In the upper third we have the superior and inferior profunda arteries coming off; their position is not always the same, and in the extreme lower third the anastomotica magna artery. These arteries continue down the outer and inner arm and anastomose with the recurrent radial and ulnar arteries, thus furnishing collateral circulation. Thus if the fluid is injected in the middle third, toward the heart, these branches that come off the brachial in the upper third will convey the fluid down the arm, filling the branches below the point of injection, which supply the forearm and the hand.