File:The breast- its anomalies, its diseases, and their treatment (1917) (14734055876).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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Text Appearing Before Image:
CARCINOMA S8i avoided. Considerable traction may, however, be exercised on the mesial flap and on the lower portionof the outer flap. Whatever the size and shape of the grafted defect, it should usually extend to the top of the axillaryfornix. Thus the thoracic or inner wall of the apex of the axilla is always lined with skin grafts. Thearm is adducted 90 or more degrees during the stitching of the wound and is not included in the dressing.Only the gentlest pressure is exerted by the bandage holding in place the gauze handkerchief which shouldbe evenly applied with solicitous care. Particularly to be avoided is the placing of a wedge of gauze inthe axillary forrux, and the using of this as a kind of fulcrum to be bridged over by the adducted arm.Drainage is unnecessary. Movements of the arm as free as possible are encouraged after the secondday.
Text Appearing After Image:
Fig. 204.—Halsteds method of radical amputation of the breast. The edges of the skin are sewed tothe sides of the chest wall and the defect is covered with Thiersch grafts. Skin Grafting in the Operation for Carcinoma of the Breast.—Of late years we havenot used skin grafts in the primary operation; complete closure of the wound is usuallypossible if the flaps are sufficiently undermined, and we can see no objection to this pro-cedure. Occasionally it becomes necessary to fashion a flap to meet the exigencies ofthe particular case and sometimes it is necessary to make small incisions in the flaps oneither side of the primary incision to relieve the tension, but this is exceptional. In rareinstances, necrosis of the flaps takes place about the mid-point of the incision where the 582 THE BREAST flaps are under the greatest tension and if the resulting defect be large, it must be closed;under these circumstances skin grafting is preferable to any plastic method.

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