Shoulder
Anterior (Deltopectoral) Approach
Position:
Landmarks:
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Coracoid process
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Deltopectoral groove - often easier to see - especially in a thin pt where the cephalic vein can be seen
Internervous plane:
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Deltoid (axillary nerve)
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Pectoralis major (medial and lateral pectoral nerves)
Incision:
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Starting just above the coracoid make a 10-15cm incision in the line of the delto-pectoral groove
Superficial Surgical Dissection:
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Using the cephalic vein as a marker , identify the delto-pectoral groove.
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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.
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Split the deltoid and pec major.
Deep Surgical Dissection:
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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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