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Brachial Plexus Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Janice He, Bassem Elhassan, Rohit Garg
All three cords give branches before proceeding as the terminal branches, which are detailed below. The lateral cord gives off the lateral pectoral nerve and the medial cord gives off the medial pectoral nerve, which together innervate the pectoralis major, which forward flexes, adducts and internally rotates at the shoulder. The medial cord also provides medial brachial cutaneous nerve and medial antebrachial cutaneous nerve which provide sensory innervation to the medial aspect of arm and forearm respectively.
Complications of upper extremity bypass grafting for occlusive and aneurysmal disease
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
The axillary artery can be exposed for bypass from the infraclavicular or delta-pectoral approaches. For the infraclavicular approach, the patient is positioned with the arm extended, and a shoulder roll is placed to help with exposure. The incision is made a finger breadth (1–2 cm) below the middle third of clavicle, and the pectoral fascia is divided. The pectoralis major muscle fibers are separated in the direction of the incision. This exposes the clavipectoral fascia, which is divided to reveal the axillary neurovascular bundle. The pectoralis minor is retracted laterally to improve exposure. The vascular structures encountered will be the axillary vein first as it is anterior to the artery, which is posterior and superior to the vein. Overlying vein branches are ligated and the vein is retracted inferiorly to expose the artery. The brachial plexus usually lies deep to the axillary artery and should be identified to avoid an inadvertent clamp injury. At this juncture, the artery can be dissected free. The lateral pectoral nerve can cross the axillary artery and should be identified to avoid injury.
General plastic
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
The Palmer and Bachelor modifications aimed to reduce the donor morbidity: The upper portion of the sternocostal head is left intact.The lateral pectoral nerve and as much as possible the medial nerve are left intact.
Application of CUBE-STIR MRI and high-frequency ultrasound in contralateral cervical 7 nerve transfer surgery
Published in British Journal of Neurosurgery, 2023
Ai-Ping Yu, Su Jiang, Hua-Li Zhao, Zong-Hui Liang, Yan-Qun Qiu, Yun-Dong Shen, Guo-Bao Wang, Chunmin Liang, Wen-Dong Xu
On high-frequency ultrasound it was unfeasible to image the whole C7 nerve because its anterior and posterior divisions join into cords behind the clavicle (Figure 3A). However, ultrasonography could show supraclavicular brachial plexus and identify small branches from the region between the C7 intervertebral foramen and the clavicle and could image their course. For example, we found a small branch form the middle trunk which was about 3 cm from intervertebral foramen when the ultrasound was used to scan cross sections of C7 nerve (Figure 3B). In fact, a small branch was found during the surgery, which was exactly derived from the middle trunk about 3 cm distant from the intervertebral foramen (Figure 3C, D). Then, intra-operative EMG was performed to confirm the branch as the lateral pectoral nerve (LPN) derived from the middle trunk to innervate pectoralis major. Commonly, pectoralis major branches are derived from anterior divisions of upper and middle trunk, which makes it feasible to detect anatomic variation of the branches of supraclavicular C7 nerve through ultrasound.
Role of Intraoperative Nerve Monitoring in Postoperative Muscle and Nerve Function of Patients Undergoing Modified Radical Mastectomy
Published in Journal of Investigative Surgery, 2021
Serhat Tokgöz, Ebru Karaca Umay, Kerim Bora Yilmaz, Muzaffer Akkoca, Melih Akinci, Cem Azili, Mehmet Saydam, Yasin Ucar, Şener Balas
Radical mastectomy, which was long performed in breast cancer surgery, was replaced by modified radical mastectomy (MRM) in the 1970s. Breast-conserving surgery and oncoplastic surgical treatment protocols adopted in recent years have gained importance in the treatment of breast cancer [1, 2]. Despite these improvements in breast cancer treatment, MRM remains an important surgical treatment protocol [3]. The most common early complications of MRM are seroma formation, surgical site infection, flap necrosis, hematoma, and other major complications that are more important and permanent including nerve injuries, shoulder and arm impairments, and lymphedema [4, 5]. Problems related to nerve injury in patients undergoing axillary dissection are common in clinical practice. Radiotherapy may also cause nerve and muscle injuries. During MRM, there is a risk of injury to four nerves with motor functions: lateral pectoral nerve (LPN), medial pectoral nerve (MPN), thoracic longus nerve (TLN), and thoracodorsal nerve (TDN). The incidence of nerve injury related to breast cancer surgery is often unrecognized and underdiagnosed if specific physical examination and tests are not employed. No study to date has shown the incidence of injury of the MPN, LPN, and TDN nerves in breast cancer surgery in the literature; however, the incidence of TLN injury is reportedly 0.6–74.7% [6].
Muscle flaps for sternoclavicular joint septic arthritis
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Barkat Ali, Timothy R. Petersen, Anil Shetty, Christopher Demas, Jess D. Schwartz
Important anatomical considerations at the time of resection and debridement of the SC joint are knowledge of the vascular pedicle and its innervation. The vascular pedicle to the central sternocostal segment of the pectoralis major muscle is the inferior, pectoral branch of the thoracoacromial artery which proximally runs deep to the muscle. Preservation of this blood supply is important for future reconstruction [11]. Innervation of the pectoralis major muscle is dual; medial and lateral pectoral nerves. This is important to avoid denervation of the sternocostal segment during elevation of the clavicular head [12]. There are studies describing different configurations of pectoralis major muscle, but in our series all patients received rotation advancement without release of the humeral head in case of ipsilateral flaps and with release in case of contralateral flaps [13–15]. Use of pectoralis major muscle flap after complete detachment of its origin and insertion has also been described [16].