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Skin and soft tissue
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Third part – subscapular artery (largest branch), which runs down the posterior axillary wall and divides into the circumflex scapular and the thoracodorsal arteries, and the medial and lateral circumflex humeral arteries.
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 third part of the axillary artery has three branches: the sub-scapular artery, the anterior circumflex humeral artery, and the posterior circumflex humeral artery. As its name indicates, the subscapular artery runs inferiorly near the subscapular nerves. It then divides into the thoracodorsal artery—which, like the thoracodorsal (or middle subscapular) nerve, goes to the latissimus dorsi—and the circumflex scapular artery that goes to muscles of the posterior surface of the scapula. The anterior and posterior circumflex humeral arteries course, respectively, ante-riorly and posteriorly to the surgical neck of the humerus, the latter artery passing through the quadrangular space of the back together with the axillary nerve (Plate 4.7b). Why does the body have circumflex blood vessels that surround a skeletal structure (e.g., the scapula or humerus) to meet with their counterparts? The answer is that such a circulatory anastomosis (connection)—between arteries or between veins provides a backup route for the flow of blood if one route is blocked or compromised.
The Small Intestine (SI)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Dorsal scapular artery: This artery arises either from the transverse cervical or subclavian artery, runs deep to the levator scapulae muscle, and supplies the rhomboid muscles. The dorsal scapular artery joins with other arteries (the suprascapular and the subscapular, via the circumflex scapular) around the scapula to form arterial anastomoses. This collateral circulatory route provides another avenue of blood flow in the event of an interruption of blood supply through either the subclavian or axillary arteries. This interruption may result from ligation, in cases of a lacerated axillary or subclavian artery, or from vascular stenosis in the axillary artery secondary to atherosclerosis. In either situation, blood flow in the subscapular artery reverses direction, thereby allowing blood to reach the third part of the axillary artery. (The subscapular artery receives blood from the suprascapular, transverse cervical, and intercostal arteries via several anastomotic junctures.)
Anatomical feasibility study of the infraspinatus muscle neurotization by lower subscapular nerve
Published in Neurological Research, 2023
Aneta Krajcová, Michal Makel, Gautham Ullas, Veronika Němcová, Radek Kaiser
Complex scapular fractures are operated via the Judet posterior approach in which the skin incision is made along the scapular spine and curved caudally along the medial edge of the scapular body. Then, the infraspinatus muscle is detached from the floor of the infraspinous fossa [11,23]. Therefore, we used the same approach in our study. The circumflex scapular artery, a branch of the subscapular artery, is the only structure (with accompanying veins) passing through the triangular space [12]. It then runs on the ventral surface of the infraspinatus muscle. After the mobilization of the IB-SSN, this vessel can be therefore used as a guiding structure for dissecting the ‘tunnel’ from the infraspinous fossa into the triangular space [12] (formed by teres minor and major muscles and long head of the triceps). For approaching this space, it is recommended to cut the skin between the teres muscles. Therefore, we propose to make a U-shaped skin incision for LSN – IB-SSN nerve transfer (Figure 7). In revision cases after previous orthopaedic procedure for scapular fracture performed via the Judet approach, the incision should follow the primary cut and then be prolonged caudo-laterally parallel to the scapular spine.
Early tangential excision debulking after free latissimus dorsi flap reconstruction for soft tissue defects: presentation of three cases
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hiroko Murakami, Kazuo Sato, Yuta Izawa, Tatsuhiko Muraoka, Yoshihiko Tsuchida
A 66-year-old man was caught in a cultivator machine. It took more than 3 h to rescue him from the machine. Upon hospitalization, the patient was in a shock state due to blood loss. He was transferred to our hospital 7 h after his injury (Figure 2(A,B)). Although we performed emergency debridement thoroughly, the wound was contaminated, and an infection developed. Several debridement procedures were needed because of wound infection before bone fixation. After the infection subsided, soft tissue reconstruction was performed using free LD flap at 4 weeks after injury (Figure 2(C)). The subscapular artery (SSA) with the circumflex scapular artery (CSA) were interposed to anastomose between the transected TP. The TDV was end-to-end anastomosed with the accompanying vein of TP. On day 6 after flap reconstruction, the first tangential excision was performed, and several tangential excisions were repeated using a razor blade, arthroscopic shaver, and hydrosurgery system (Figure 2(D)). Full-thickness skin graft (FTSG) was performed at 4 weeks after free flap reconstruction. The wound healed without complications. The patient could walk with regular shoes without assistance (Figure 2(E)).
Free serratus anterior fascial flap combined with vascularized scapular bone for reconstruction of dorsal hand and finger defects
Published in Case Reports in Plastic Surgery and Hand Surgery, 2018
Takeshi Kitazawa, Masato Shiba, Kazuhiro Tsunekawa
The wound was temporarily covered with artificial dermis and reconstruction was performed 14 days after injury. After surgical debridement, an 8 × 8-cm area of serratus fascia and a block of bone measuring 3 × 1×0.5 cm from the scapula on the angular branch of the thoracodorsal artery were harvested concomitantly (Figure 3). The angular branch arose from the serratus anterior pedicle of the thoracodorsal artery and the length of the pedicle dissected to the bifurcation of the subscapular artery was 8 cm. After setting the harvested bone block in the defect and suturing the disrupted tendon, a fascial flap was placed over the wound. A split-thickness skin graft from the ipsilateral chest wall in the same operative field was grafted on the fascial flap. In the anatomical snuff box, the artery of the flap was anastomosed to the radial artery and the vein of the flap was anastomosed to the cephalic vein in end-to-end fashion.