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Vascular Trauma
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
However, in terms of exposing the axillary artery in the classical way, this is how it is done:Transverse incision about 8–10 cm in length, around 1 cm below the clavicle, starting at its medial third and running across towards the coracoid process (there is a natural dip in the infraclavicular fossa you can feel with your fingers).Dissect down through skin, subcutaneous tissue, and clavipectoral fascia.Now, split the pectoralis major muscle in the line of its fibres. You can use a big self-retaining retractor to improve exposure.You should see the pectoralis minor muscle with its insertion onto the coracoid process.There are a number of ways to divide the pectoralis minor muscle. One is to get underneath it with a swab, pull the swab up, and divide with monopolar diathermy. Another option is to use a Lahey and divide chunks of muscle at a time. Whatever you do, just be wary of the brachial plexus and neurovascular structures running underneath i.e. be gentle.The axillary artery should now be lying right in front of you.
Lymphatic anatomy: lymphatics of the breast and axilla
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
The pectoralis major muscle is a fan-shaped muscle with two divisions. The clavicular division originates from the clavicle and can be easily distinguished from the larger costosternal division that originates from the sternum and costal cartilage of ribs 2–6. These fibers converge on the greater tubercle of the humerus. The pectoralis minor muscle is located beneath the pectoralis major muscle and arises from the external surface of ribs 2–5. The posterior suspensory ligaments extend from the deep surface of the breast to the deep pectoral fascia. The subscapular muscle arises from the first rib near the costochondral junction and extends laterally to insert on the inferior surface of the clavicle.
Upper Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo
The fibers of the left and right pectoralis major muscles may fuse over the sternum (Macalister 1875; Snosek and Loukas 2016; Standring 2016). In rare cases, the entire pectoralis major muscle may be absent or even doubled (Macalister 1867a, 1875; Bergman et al. 1988; Upasna et al. 2015; Snosek and Loukas 2016). Pectoralis major is associated with supernumerary muscles including sternalis, pectoralis quartus, pectorodorsalis, and chondroepitrochlearis (see these entries).
Brachial artery trauma as a complication of bicep muscle injury
Published in Baylor University Medical Center Proceedings, 2023
Charles Graham, Sarah Bergkvist, Peter Kimball, Katelyn Taylor, Mudassir Syed, Michael M. Mohseni
A 48-year-old man presented to the emergency department with complaints of swelling, pain, and limited range of motion of the right upper extremity (RUE). His symptoms began after feeling a pop in his right arm while losing an arm-wrestling contest 48 hours earlier. He was evaluated 12 hours after the initial injury and diagnosed with a possible bicep tendon rupture. At that time, the patient was discharged with a sling, pain medications, and orthopedic follow-up. He experienced worsening RUE swelling, numbness, paresthesias, and uncontrolled pain, prompting a return visit to the emergency department. The patient endorsed a history of untreated hypertension and testosterone use but denied any surgeries. His exam was significant for swelling and tenderness extending from the right anterior chest near the pectoralis major muscle distally to the antecubital fossa and forearm. Diffuse ecchymoses was present in the medial upper arm. He reported significant pain with active or passive range of motion testing of the RUE, thus limiting strength examination. The right radial pulse was difficult to palpate given the degree of swelling, but bedside Doppler ultrasound confirmed the presence of good pulse waveform. Laboratory evaluation was notable for a creatinine of 1.36 mg/dL and a creatine kinase of 520 U/L. Orthopedic surgery was consulted given concerns for development of compartment syndrome.
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
To enable pectoralis major muscle functions, preserving the MPN in particular is mandatory due to its innervation of the clavicular and sternal parts of the muscle [20]. The LPN innervates the proximal part of the pectoralis major muscle; in cases in which these nerves are not protected by careful dissection, the pectoralis major muscle undergoes fibrosis, atrophy, and shortening, its volume is decreased, shoulder movements are limited, and chest wall deformities occur. Preservation of these nerves is also important to enable breast reconstructions. However, it is difficult to preserve them during surgery due to their lengths being 10.06 cm and 8.6 cm, their branching, and anatomic variations [21, 22]. Goncalves et al. [23] demonstrated the correlation between MPN preservation pectoralis major muscle strength. In addition, Akkoca et al. [18], who work in the breast surgery unit of our clinic, demonstrated that pectoralis major muscle functions were better when the LPN was protected by careful dissection, which supports the results of Goncalves et al. [23] In our study, the better results obtained in EMG and US measurements of pectoralis major muscle functions in the IONM group than in the CND group were correlated with the better determination of the branched structure and variations of the LPN and MPN with nerve monitoring. Another reason for this finding is that, due to the structures of both nerves, many terminal and accessory branches cannot be preserved by careful dissection alone.
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].