Amputation of the female breast / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Amputation of the female breast / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    glauds tliere. Having lifted up the great pectoral muscle, look in aud feel with your fingers; push the fingers between the pectoral muscles all the way up above the lesser pectoral to the clavicle, i. e., to the space of Mohreuheim, where you will often find a dis- eased gland. When you have taken out the whole breast; when you have excised all the infiltrated skin ; when you have removed the fascia and, if need be, the pectoral muscle; when you have cleaned out the axilla; when you have gone between the two pectoral mus- cles aud have cleaned out the space of Mohrenheim, then you have done a complete modern operation; then you will be rewarded not by the 12 per cent, of cures of 1880, but by the 25 or 30 per cent., aud in early eases by the even possible 50 per cent., of 1894. Sometimes you will find it impossible to reclose the wound. So much skin has been taken away that it is not possible to approx- imate the edges. There are two methods remaining ; one is to take a bit of skin from the arm or thigh and transplant it bodily to close in the raw space, or later upon the granulating surface (Thiersch's method). The other is a method which you have all adopted at various times., that is, by undermining the skin above or below and then sliding it so as to make it cover the opening. Shrady some time ago suggested a modification of this, that instead of simple undermining aud sliding we should dissect both above aud below the wound two flaps, each with a broad pedicle, and slide them up and down respectively. If need be, the skin above and below can then itself be uudermined and the wound thus be closed. I used this method not very long ago on an exceedingly large sarcoma, and I observed one thing which led me a little to question whether the detail might not be changed to advantage, viz., the two outer flaps united very nicely, but of the two inner a con- siderable portion became gangrenous, due to the difference of blood supply to the.outer and inner flaps. The outer flaps have a favor- able blood supply fr^jm the vessels of the axilla, but the pedicles of the inner flaps reach the middle line where the blood-vessels are small aud do not afford an ample blood supply by inosculation. After you are through, one question remains—that of drainage. You know that the trend of surgical sentiment is strongly in favor *)f doing without drains, and I believe in that. A drain is a door