Abstract HALSTED,1 when closing wounds of radical mastectomy, stitched the axillary flap of skin "by interrupted, buried sutures of very fine silk to the fascia just below the first rib in such a way that the skin partly enveloped the large vessels." Up to 1913, Halsted apparently sutured the axillary skin flap only when grafting skin; since 1949 others2 have begun to suture the axillary skin flap not only when grafting, but also when not grafting, for reasons which will appear in this paper. It is the axillary flap, rather than the chest flaps, which is most in need of basting, whether skin is grafted or whether it is not grafted, a fact which it took us years to appreciate. For obtaining uncomplicated healing of mastectomy wounds, suture fixation of the axillary skin flap has proved superior to mechanical pressure in the axilla. Objectives, however, are identical whether suturing References 1. Halsted, W. S.: Developments in Skin-Grafting Operation for Cancer of the Breast , J. A. M. A. 60:416 ( (Feb. 8) ) 1913.Crossref 2. (a) Byars, L. T.: Personal communication to the author. 3. (b) Orr, T. G.: Symposium on Recent Advances in Surgery: Radical Operation and Palliative Therapy for Carcinoma of the Breast , S. Clin. North America 29:1341 ( (Oct.) ) 1949. 4. Orr, T. G., Jr.: An Incision and Method of Wound Closure for Radical Mastectomy , Ann. Surg. 133:565 ( (April) ) 1951.Crossref 5. (c) Urban, J. A., and Baker, H. W.: Radical Mastectomy in Continuity with En Bloc Resection of the Internal Mammary Lymph-Node Chain , Cancer 5:992 ( (Sept.) ) 1952.Crossref 6. Blair, V. P.: The Influence of Mechanical Pressure on Wound Healing , Illinois M. J. 46:249 ( (Oct.) ) 1924. 7. Raffl, A. B.: The Use of Negative Pressure Under Skin Flaps After Radical Mastectomy , A. M. A. Arch. Surg. 136:1048, 1952.
A.M.A. Archives Surgery – American Medical Association
Published: Apr 1, 1953
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