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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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