Shoulder

Anterior (Deltopectoral) Approach

Position:

• Beach chair

Landmarks:

• Coracoid process
• Deltopectoral groove - often easier to see - especially in a thin pt where the cephalic vein can be seen

Internervous plane:

• Deltoid (axillary nerve)
• Pectoralis major (medial and lateral pectoral nerves)

Incision:

• Starting just above the coracoid make a 10-15cm incision in the line of the delto-pectoral groove

Superficial Surgical Dissection:

• Using the cephalic vein as a marker , identify the delto-pectoral groove.
• The vein can be taken either medially or laterally - some advocate taking it mediallyt with a small cuff of deltoid to reduce number of tributaries that need ligation - this small cuff is then denervated however.
• Split the deltoid and pec major.

Deep Surgical Dissection:

• The conjoint tendon of coracobrachialis and the short head of biceps can be retracted medially to expose the subscapularis tendon. However,
  
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