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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 internal mammary artery medially (65%) and the lateral thoracic artery (35%) supply blood to the breast (Figure 7.1). The cephalic vein serves as a landmark separating the pectoralis major muscle from the deltoid muscle. The vein travels through the deltopectoral triangle and pierces the clavipectoral fascia, joining the axillary vein. Branches of the brachial plexus are located throughout the course of the axilla. The long thoracic nerve is located on the medial wall of the axilla, arising in the neck from the fifth, sixth, and seventh roots of the brachial plexus. It innervates the serratus anterior muscle, which permits raising the arm above the shoulder. The intercostobrachial nerve is the lateral cutaneous branch of the second intercostal nerve and the joining of the medial cutaneous nerve of the arm, supplying the skin of the floor of the axilla and the upper medial aspect of the arm.
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 second part of the axillary artery has two branches: the thoracoacromial trunk and the lateral thoracic artery. The name “thoracoacromial trunk” refers to its large area of distribution, from the thoracic region to the acromion region. This trunk has an acromial branch going mainly to the region of the acromion, a deltoid branch accompanying the cephalic vein in the deltopectoral groove, a pectoral branch supplying the pectoralis major and minor, and a clavicular branch supplying the subclavius. The lateral thoracic artery is named logically, as this artery is lateral to the pectoralis minor—the landmark for the second part of the axillary artery—and supplies blood to the thoracic region, namely, to the pectoralis major and minor and to the lateral thoracic wall.
Anatomy
Published in Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury, OSCEs for the MRCS Part B, 2017
Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury
Blood supply to the breast is mainly derived from the lateral thoracic artery (a branch of the second part of the axillary artery). However, the internal thoracic, thoracoacromial and posterior inter-costal arteries also send branches to the breast.
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
The reconstruction of SC wounds depends on the vascular pedicle [2,4]. The first choice is use of pectoralis major muscle, either as rotation advancement flap based on thoracoacromial pedicle or as turn over flap based on internal mammary artery, IMA perforators. Pectoralis major muscle is a type V flap which derives its blood supply from thoracoacromial artery, the lateral thoracic artery, the IMAs and, to a lesser extent, the superior thyroid artery [10]. Given the centrality of the wound flaps from either side can be used. When using pectoralis as rotation advancement flap from contralateral side, either because of unavailability of the ipsilateral pectoralis major due to thoracoacromial pedicle sacrifice, or the need for bilateral flaps, we recommend releasing the medial humeral head tendon which aids in rotation and advancement. Although pectoralis major muscle turn over flap has been described for sternal wounds, we do not recommend it given the unreliability of the internal mammary artery pedicle from the debridement required to clear the infection.
The Safety and Efficacy of a Minimalist Approach for Percutaneous Transaxillary Transcatheter Aortic Valve Replacement (TAVR)
Published in Structural Heart, 2020
Yumiko Kanei, Waqas Qureshi, Nirmal Kaur, Jennifer Walker, Nikolaos Kakouros
Direct percutaneous transaxillary access was obtained with the arm abducted at 45º under direct ultrasound and fluoroscopic guidance with the use of a micropuncture system and modified Seldinger technique (Figure 1b,c). We aim to obtain access at the very distal end of the first part of the axillary artery, just proximal to the lateral thoracic artery, identified using ultrasound guidance. Depending on the anatomy, access just distal to this branch may also be obtained to allow sufficient distance between the access site and the subclavicular portion of the vessel, so as to facilitate open surgical repair if needed and manual compression of the proximal segment of the artery against the second rib. Two Perclose Proglide™ closure devices (Abbott Vascular, Abbott Park, IL, USA) were placed for preclosure, and an 8Fr sheath was inserted. Manual pressure proximal to the access site was applied during exchanges.
Management of severe hemoptysis
Published in Expert Review of Respiratory Medicine, 2018
Antoine Parrot, Sebastian Tavolaro, Guillaume Voiriot, Antony Canellas, Jalal Assouad, Jacques Cadranel, Muriel Fartoukh
Systemic hypervascularization may also arise in the non-bronchial systemic circulation (which includes the internal mammary artery, the phrenic arteries, etc.) or from neo-vasculature that appears owing to pleural symphysis. The non-bronchial artery involved depends on the location of the pulmonary pathology. Hence if the apical region is affected, the hypervascularization may arise in the internal mammary or lateral thoracic artery or from the subclavian arteries, whereas if the basal regions are affected, it is the pulmonary ligament arteries or phrenic arteries that should be checked. The frequency of this cause of hemoptysis varies between 40% and 88% [35]. This hypervascularization is always accompanied by bronchial hypervascularization.