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
KEYES EL, HAWK BO, SHERWIN CS. BASTING THE AXILLARY FLAP FOR WOUNDS OF RADICAL MASTECTOMY. AMA Arch Surg. 1953;66(4):446-451. doi:10.1001/archsurg.1953.01260030461012