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Upper Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The brachial fascia or deep fascia of the arm is formed by connective tissue that is continuous proximally with the pectoral fascia and the axillary fascia and distally with the antebrachial fascia or deep fascia of the forearm. Importantly, it is also connected to the medial and lateral sides of the humerus by intermuscular septa, forming the posterior (extensor) compartment of the arm and the anterior (flexor) compartment of the arm. The anterior compartment includes the muscles biceps brachii, brachialis, and coracobrachialis (Plate 4.10), which are innervated by the musculocutaneous nerve and form a developmental and evolutionary unit (Table 4.3). Students often confuse the long and short heads of the biceps; however, it is easy to remember once you realize that the long head is actually longer because it originates from the supraglenoid tubercle of the scapula, while the short head originates from the inferior tip of the coracoid process of the scapula. The posterior compartment includes the triceps brachii (Plate 4.11), which has a long head, a lateral head, and a medial head, and is innervated mainly by the radial nerve (Table 4.4). Most atlases and textbooks state that the anconeus is a posterior arm muscle developmentally related to the triceps brachii, but it is actually a posterior forearm muscle that is developmentally and evolutionary closely related to the extensor carpi ulnaris (see Section 4.3.3).
Pectoral Region and Breast
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
The Axillary Sheath. Following the reflection of the pectoralis minor, the axillary vein, partially hidden by the axillary fascia, and the axillary artery can now be partially inspected. Removal of the axillary fascia, however, should be deferred to a later time, when the axilla is completely dissected.
Axillary sentinel node biopsy in prone position for melanomas on the upper back or nape
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Lutz Kretschmer, Simin Hellriegel, Naciye Cevik, Franziska Hartmann, Kai-Martin Thoms, Michael P. Schön
The axillary SLNs are accessed by the either a transverse or horizontal cut at the level of the hotspots marked by the nuclear medicine specialist. The incision is mostly only 4–5 cm in length. Sharp retractors are inserted in vertical or horizontal direction. After the incision of the subcutaneous fatty tissue, the lateral margin of the M. latissimus dorsi is exposed. Then, the axillary fascia is opened in horizontal direction ventro-laterally from the lateral edge of the muscle. If the Latissimus is particularly well developed, its lateral margin is mobilized and lifted in dorsal direction using a Roux or a Langenbeck retractor. During SLNB in prone position, the gamma probe points mainly in ventro-medial direction and therefore picks up no scattered radiation originating from the primary tumor site (Figure 2). Redon’s drainage and wound closure complete the procedure. Wide excision of the primary tumor site is then performed without the need to re-position the patient. Following wound dressing, the patient is ‘rolled back’ onto a hospital bed without much effort.
An innovative technique of hydrosurgery in the treatment of osmidrosis
Published in Journal of Dermatological Treatment, 2021
Minliang Wu, Haiying Dai, Ji Zhu, Jianguo Xu, Chuan Lv, Mengyan Sun, Chunyu Xue, Yuchong Wang
After the hair-bearing area of bilateral axilla is marked and local anesthesia, the long axis of undermining area was divided into three equal parts. Two 3-cm-long parallel incisions were made transversely at the two equal diversion points, on the axillary crease. Subdermal undermining of the marked area was performed using dissecting scissors. The flap was turned over and a fine-pointed scissors was used to remove the apocrine glands. Bleeding points were controlled using an electric coagulator. The incisions were closed with interrupted sutures without anchoring to the axillary fascia.
Removing the apocrine sweat glands with nasal endoscope assisted suction cutter: a new technique in the treatment of axillary odor
Published in Journal of Dermatological Treatment, 2022
Zhiqiang Wang, Ruike Cao, Quan Liu, Yan Hu, Qi Zhao, Linlin Liu, Ran Du
In the endoscopic group (study group), subcutaneous apocrine sweat glands were excised with the nasal endoscope assisted suction cutter. A 1–1.5 cm incision was made in the middle and posterior axillary hair area (Figure 1), Tissue scissors were combined and separated along the superficial fascia of the upper layer of the axilla, forming a subcutaneous artificial lacuna covering all areas of the apical sweat glands. The flap was suspended with 3–0 silk thread, and the assistant aided in pulling the suture to expose the lacunae (Figure 2). A 70° nasal endoscope (Olympus Corporation) was used to detect whether the space of the cavity reached 1 cm beyond the axillary hair area. During the exploration, enlarged pink apocrine sweat glands could be seen (Figure 3). After adequate hemostasis, the speed of the suction cutter (Stryker, inc)was adjusted to 2000–3000 RPM, and the negative pressure was set to 20–30 mmHg. Under the endoscopic vision, the subdermal fat and apocrine sweat glands were completely absorbed and removed (Figure 4). The end point of suction and cutting was to see the porcelain white dermis and there was sharp difference between the cut part and that not operated (Figure 5). During the resection, attention was paid to the protection of dermal vascular network and skin flap, hair follicles could be removed together, and there was no apocrine sweat gland between the fat and the skin at the end point of cutting and sucking. After the suction and cutting, the smooth flap was clearly observed in the surgical field. After no residual sweat glands or active bleeding, the flap was fixed on the axillary fascia with suture for 3–5 stitches, and the drainage strip was placed to close the surgical incision.The armpits were evenly filled with gauze and the 3 M bandages were pressurized to cover the bilateral axils (Figure 6). The drainage strip was removed 48 h after the operation (Figure 7), the axilla was bandaged under pressure for 5–7 days, and the vigorous activity of the upper limb was restricted for 1 week (Figure 8). The stitches were taken out 7–10 days after the operation, and rehabilitation exercise began 2 weeks after the operation.