Later, it was found that subcutaneous lymphatic vessels could be directly or indirectly invaded by tumors, and the skin flap became thinner. Very demanding on knife skills. We need to find a reasonable level in a bloody battle and maintain it perfectly. Higher requirements are put forward not only for the surgeon, but also for the assistant. We can only stop bleeding first, and the amount of bleeding is large. At this time, the electrotome gradually became the protagonist of the free flap from the auxiliary hemostatic tool. Because the main surgeon can stop bleeding immediately, keep a clear vision and do not need the help of an assistant, the difficulty of operation is obviously reduced, the amount of bleeding is reduced and the operation time is shortened. Doctors who were blocked by skin flaps freely walked into the door of radical mastectomy.
Later, it was said that superficial lymphatic vessels are connected with deep lymphatic vessels, and tumor cells may also invade and need to be included in the scope of resection. Then the free surface is close to the skin, almost reaching the level of full-thickness flap. This degree is almost all oozing blood, and it is close to the skin, and the electrotome has no advantage at all. The bigger effect is skin flap necrosis. Because the subcutaneous vascular network is removed, the flap relies on interstitial tissue fluid in the early stage and regenerated blood vessels in the later stage, which closely links the flap necrosis with subcutaneous effusion. Moreover, the slow necrosis and healing of this flap makes people unable to sleep. At this time, the scalpel, which is no longer in the scenery, made a comeback, especially the application of hemostatic water, once again occupied a dominant position. However, not everyone agrees with such a thin flap, and the original free method is still widely used. In the free flap, it is not a big problem to exceed the preset boundary, but some boundaries are very important anatomical landmarks, and missing them will increase the chance of accidental injury.
Above: pectoralis major-deltoid sulcus. No matter before or now, the cephalic vein should be protected.
Exterior: the anterior edge of latissimus dorsi. Fat people tend to be extroverted, while thin people tend to be introverted.
Below: Rib arch is a sign, but not a boundary. The lymphatic vessels in the lower medial part of the breast communicate with the lymphatic plexus of rectus abdominis, liver and diaphragm through the upper part of the anterior abdominal wall.
Axillary: Many people sweep their upper arms when they clean their armpits.