Surgery of the Peripheral Nerve
Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou in Operative Orthopaedics, 2020
A clavicular osteotomy may be required to facilitate access, especially if there is a vascular injury. In this case a plate should be precontoured and holes predrilled for easy fixation at the end of the procedure, remembering that the bone will be shortened by the thickness of the saw blade. Distally the pectoralis major muscle is detached from the humerus in its upper portion or, if required, its entirety. The muscle is then reflected medially exposing the clavicle, pectoralis minor muscle and clavipectoral fascia (Figure 5.12). The pectoralis minor muscle is divided at its tendon taking care not to damage the musculocutaneous nerve. The subclavius muscle is divided with the suprascapular vessels (once ligated). This exposes the entire plexus and vasculature from the first rib to the axilla.
Pedicled Flaps in Head and Neck Reconstruction
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
With the patient in the supine position, the surface markings of the acromiothoracic artery are outlined. A dotted line is marked from the acromium to the xiphoid process and a further dotted line is dropped to join this line in a perpendicular direction from the sternal notch. The point at which the line bisects the first line represents the location where the vascular pedicle meets the first line (Figure 92.11). The pedicle then runs in the direction of the first line from the acromium towards the xiphisternum. The clavipectoral fascia is then marked by a point two-thirds of the distance along the clavicle from the sternal notch to the coracoid process. The vascular pedicle runs in a curved direction downwards to meet the bisection point already described. A skin island of the appropriate size and shape may be drawn over the distal part of the artery, to facilitate a suitable arc of rotation. The borders of the skin paddle should lie between the lateral edge of the sternum medially and the nipple laterally. The incision for access should be extended into the axilla. The technique described by McGregor and McGregor2 (i.e. designing the skin incision to allow a secondary deltopectoral flap from the same side) should be considered in both males and females. This technique allows for an easier wound closure and provides a salvage flap for neck resurfacing.
Neurogenic thoracic outlet syndrome
Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long in Endovascular and Open Vascular Reconstruction, 2017
A small, vertical infraclavicular incision is made in the deltopectoral groove and carried through to the subcutaneous tissues. The pectoralis fascia is entered and the lateral edge of the pectoralis major is lifted and retracted medially. The space between the pectoralis muscles is developed bluntly; the pectoralis minor tendon is identified, encircled, then divided under direct vision close to the coracoid process with electrocautery for hemostasis. The edge of the muscle is oversewn with 2-0 silk suture. The clavipectoral fascia is also divided sharply just beneath the clavicle. This gives a palpable improvement in the subpectoral space, allowing relief if any neurovascular compression is found at this site.
Effectiveness of Ultrasound Guided Erector Spinae Plane Block Compared to Ultrasound Guided Modified Pectoral Nerves Block in Modified Radical Mastectomy: A Randomized Single Blinded Study
Published in Egyptian Journal of Anaesthesia, 2022
Mohamed Elsaid Abdel Fattah, Osama Sayed Ibrahim, Nevine Mahmoud Gouda, Mohamed Mohamed Abdel-Hak
The patient was put supine. The first rib was discovered by a high-frequency linear probe put caudal to the lateral third of the clavicle to determine the location of the axillary arteries beneath the pectoralis major and subclavian muscles. After that, the probe was advanced distally towards the axilla until it reaches the third rib. The pectoralis minor is elevated above the serratus anterior in this position, and the clavipectoral fascia continues as Gerdy’s ligament into the axilla. We injected 10 ml of levobupivacaine 0.25% into the interfacial plane between the two pectoralis muscles and 20 ml into the interfacial plane between the pectoralis minor and the serratus anterior muscles using an in-plane medial-to-lateral approach once the structures have been identified with US.
Contemporary review of management techniques for cephalic arch stenosis in hemodialysis
Published in Renal Failure, 2023
Gift Echefu, Shivangi Shivangi, Ramanath Dukkipati, Jon Schellack, Damodar Kumbala
The Cephalic vein is part of the upper extremity’s superficial venous system. It originates in the anatomical snuffbox from the radial aspect of the superficial venous network of the dorsum of the hand. Coursing along the anterolateral forearm to the elbow, it communicates with the basilic veins via median ante-cubital veins. It then courses along the lateral aspect of the biceps toward the pectoralis major muscle as it enters the deltopectoral groove (a triangular space formed by the adjacent borders of the deltoid and pectoralis major muscles Figure 2). It then passes under the clavicle, turning sharply to pierce the clavipectoral fascia terminating as the axillary vein. The cephalic arch refers to the final arch of the cephalic vein before it drains into the first part of the axillary vein.
The thoracoacromial axis in salvage head and neck reconstructive surgery, a case series
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Matthew J. Davies, Rhys van der Rijt, Roger Haddad, James Southwell-Keely
The thoracoacromial artery arises from the second part axillary artery and divides into acromial, deltoid, clavicular, and pectoral branches. The pectoral branch, which supplies the pectoralis major muscle, penetrates the clavipectoral fascia 6–10 cm lateral to the sternoclavicular joint. It then runs along the deep surface of the pectoralis major muscle encased in a protective perivascular fatty tissue (Figure 1) [8].
Related Knowledge Centers
- Axillary Artery
- Axillary Nerve
- Axillary Vein
- Fascia
- Intercostal Space
- Pectoralis Major
- Coracoid Process
- Clavicle
- Pectoralis Minor
- Subclavius Muscle