The elbow-joint being extended and the arm rotated outwards, an incision should be made, about two inches and a half long, on the internal margin of the biceps muscle. Having divided the integuments and drawn the vein or veins out of the way, the fascia should next be divided on a director. In some cases the basilic vein lies beneath the fascia in this situation. By drawing outwards the biceps muscle with a blunt retractor, the artery may be exposed, with a small vein frequently lying on either side, and the median nerve usually in front of it. The nerve is to be drawn to the inside, and the needle passed from within outwards. The operator should remember that internal and posterior to the brachial artery, in this situation, the inferior profunda artery descends in company with the ulnar nerve, the nerve lying to the inner side: to avoid tying the latter artery in mistake, he should first take care to direct the edge of his knife, not backwards, but towards the centre or axis of the humerus, and afterwards satisfy himself that the compression of the vessel stops the pulsation in the aneurismal tumor.

Should there be two vessels, and that the compression of both be found necessary to cause the pulsation of the sac to cease, both of them should be tied.

If the operations be performed in the inferior third of the arm, the surgeon will meet with the internal cutaneous nerve and basilic vein in his first incisions; and after having cut through the brachial aponeurosis he will look for the biceps tendon, the inner edge of which will be his guide to the artery in this situation : the median nerve will be found still more internally, lying at the inner side of the artery.