Anterior Upper Arm Thorax Shoulder Upper Limb Christina

Anterior Upper Arm Thorax, Shoulder & Upper Limb Christina Duncan Stacey Fain

Anatomical Landmarks • Palpations - Thoracic – Jugular Notch – Manubrium – Body and Xiphoid Process of Sternum – Sternal Angle – Acromion – Nipple

Anatomical Landmarks • Palpations – Brachial – Median epicondyle – Lateral epicondyle – Cubital fossa

Incision Lines - Thoracic • First Incision: Midline cut from jugular notch to xiphoid process – Three lateral incisions will originate from first incision. 1. 2. Midaxillary Line 3. Upper border of the manubrium to the acromion along the clavicle (A-D). Extend this incision down the arm 5 inches (D-G) and then around the arm. (G, H) From the midline laterally (encircling the pigmented areola) to the midaxillary line about 3 inches below the anterior axillary fold. (B-E) From the xiphisternal junction to the midaxilllary line following the 6 th rib. (C-F)

Incision Lines - Brachial • From first brachial circumferential incision (G, H), continue down arm approximately four inches and make another circumferential cut immediately superior to the cubital fossa (I, J). I J

Reflection of Skin - Thoracic • Start at jugular notch. Hold scalpel edge at a slight angle to underlying superficial fascia and proceed laterally. • Make an incision in reflected skin for index finger of free hand for purpose of providing traction. • GOAL: To have little or no fat adhering to deep surface of the skin, which will show many small pock marks/pits called dermal papillae. • Keep 2 skin flaps attached laterally so they can be replaced over chest to prevent drying out. • Leave nipple and areola attached to underlying tissue. In males, the nipple is directly attached to anterior thoracic wall. In females, the nipple is completely within the superficial fascia.

Reflection of Skin - Brachial • Starting from midline incision, reflect skin medially and distally, respectively. I Medial J Distal

Watch Out! • Medial Supraclavicular Nerves • Intermediate Supraclavicular Nerves • Lateral Supraclavicular Nerves

Watch Out! – Vascular

Cautionary Tales - Nerves • Medial Brachial Cutaneous Nerves • Intercostobrachial Nerves