Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
By the name of Allah Quick revision : - Axilla is a pyramidal shaped space between the arm and the chest wall. - Contents of the Axilla : 1- Axillary artery: the main arterial supply of the upper limb. 2- Axillary vein. 3- Axillary sheath. 4- Axillary lymph nodes. 5- Brachial plexus of nerves: (because the axillary nerves are oriented towards the brachium they are called brachial plexus) 6- Fat: we have multiple vital structures (arteries, veins, nerves),and since the shoulder and the arm perform excessive movements sometimes, the axillary fat prevent / minimize the occlusion of the artery or the vein. -Axillary artery in detalils : Brachial artery Axillary artery Subclavian artery - It is a continuation of the subclavian artery , Begins at the outer border of the first rib , Ends at lower border teres major and Continues as brachial artery. - Through its course it is crossed by pectoralis minor which divides it into 3 parts , Each part gives branches according to it's number . - Located inside carotid sheath and related directly to cords of brachial plexus throughout it's course . - A table illustrating the Axillary artery divisions : 1 Parts First part “ one branch “ ( above P minor ) Second part “ two branches “ ( behind P minor ) Branch/branches Highest thoracic A. - Thoracoacromial A . - lateral thoracic A. Third part “ three branches “ ( below P minor ) Note : Ant.circumflex humeral A. and the post. Circumflex humeral A. anastomose with each other around the surgical neck of humerus. - Subscapular A. - anterior circumflex humeral A. - and the posterior circumflex humeral A. 2 Function of the branch / branches Supply the first and the second intercostal spaces. -thoracoacromial A.: pierce clavipectoral fascia and gives 4 branches : 1- pectoral branches ( to P major and P minor ) 2- deltoid branch 3- acromial branch 4- clavicular branch . -lateral thoracic A. : pass along the lateral border and below the lower border of pectoralis minor and supply lateral part of breast. - subscapular A. : large in diameter and pass along the lateral and lower borders of subscapularis muscle It’d is divided into: a) circumflex scapular artrey (posterior toward the infraspinous fossa, at the lower border of subscapularis), and passes through the triangular space. b) Thoracodorsal A. -anterior circumflex humeral A. : smaller and wind around the surgical neck of humerus -posterior circumflex humeral A. : larger and wind around the surgical neck of humerus - Located inside carotid sheath and related directly to cords of brachial plexus throughout it's course. - Cords of brachial plexus are named according to their relation to the second part of the axillary artery( medial cord, lateral cord, posterior cord). First part of the axillary artery Second part Third part anterior Posterior Pectoralis major Long thoracic and the skin nerve Lateral 3 cords of the brachial plexus medial Axillary vein Pectoralis major,pectoralis minor and the skin Lateral cord of brachial plexus Medial cord of brachial plexus and axillary vein the lateral root of the median nerve Coracobrachialis , biceps , humerus and the musculocutaneous nerves axillary vein Ulna nerve, and medial custaneous nerve of arm Posterior cord of brachial plexus , subscapularis and the shoulder joint Pectoralis major Subscapularis, and medial root latissimus of the median dorsi, teres nerve major, axillary and radial nerve - Note: when removing the breast (this is called mastectomy) in some cases, the lateral thoracic nerve is also removed or ligated . Don't aim for success if you want it; just do what you love and believe in, and it will come naturally Arterial anastomosis around the scapula : - An arterial networks form on the anterior and posterior surfaces of the scapula between many branches from subclavian artrey and axillary artrey to compensate for temporary occlusion of the axillary artrey during excessive movements. 3 We call this “Detour” : ‘collateral circulation’. This circulation also happens with the patients having a disease called ‘atherosclorosis’. - The most important collateral circulation occurs in the heart. Because the blood vessels profusely anastomose with each other, that’s why Heart attack doesn’t occure quickly. - from subclavian A. : - from axillary A . : a) suprascapular A. b) Deep branch of transverse cervical artery A) subscapular A. B) Ant and post. Circumflex humeral arteries. - oclussion causes low pressure - if a part of the axillary artrey (narrowed, injured, occlused) the blood will come from the arterial anastomoses around the scapula. For example : sometimes due to excessive movement you may kink the second part of the axillary artrey or if there is a mass which will obstruct the second part, blood will come to the third part through the suprascapular artrey over the suprascapular ligament to the infraspinous fossa then to the cicumflex scapular A. (the blood is now flowing in the opposite direction) then to the subscapular artrey then to the brachial artery. - Suprascapular artrey brachial artrey , infraspinous fossa, circumflex scapular A. , subscapular A. , - Also there is another “detour” which is as the following: Transverse cervical artery > its deep branch passes along the medial border of the scapula>> to the inferior border of it >> then it will anastomose with the circumflex scapular artery. Note: transverse cervical A. gives : A) superficial branch b) Deep branch (medial border of the scapula) 4 - There are no valves in arteries .on the other hand veins have many valves - If someone stands a lot or if the woman is pregnant the blood will be congested in the veins of the lower limb causing a disease called ‘varicose veins’. - Axillary vein : - Begins at lower border of teres major by the union of basilic vein and veins of brachial artery , Passes upward medial to axillary artery , ends at outer border of the 1st rib to continue as the subclavian vein and it Receives the cephalic vein at its end. - The clavipectoral facsia is pierced by each of the following: 1) 2) 3) 4) Cephalic vein. Lateral pectoral nerve. Thoracoacromial artery. Lymph. Central line catheterization : In some chronic cases (e.g : cancer patient who is being treated by chemotherapy ) we are forced to insert a catheter (a needle in the subclavian vein just below the clavicle) in order to give fluids, drugs, monitor central venus pressure, monitor blood gases or to take a sample of blood. Procedure: 1) Put your index finger on the superior end of the sternum (sternal notch) 2) Put the thumb on the mid point of the clavicle. 3) Below your thumb, insert the needle - Note: if the needle inserted too far posteriorly, it may injure the subclavian artery causing severe bleeding. A successful man is one who can lay a firm foundation with the bricks others have thrown at him 5 6