Master Tech Ortho Surgery Elbow CH1
PART I Exposures
Anterior humeral circumflex artery
Insertion of pectoralis major
Long head of biceps tendon
Distal Extension Note : For a distal expansion, the skin incision is carried distally over the lateral margin of the biceps muscle to the extent needed. ●● The brachial fascia is split distally, exposing the lateral margin of the biceps. The cutaneous por- tion of the musculocutaneous branch of the nerve is identified and protected as it emerges from the lateral margin of the biceps distally. ●● The brachialis muscle is identified along with the interval between the brachialis and the brachio- radialis muscles. The interval is developed by sharp dissection (Fig. 1A-4A and B). Note : Alternately, the brachialis muscle may be split longitudinally in line with the lateral margin of the biceps muscle. ●● The radial nerve is palpated or observed on the undersurface of the brachioradialis (Fig. 1A-5) and is exposed by sharp dissection. ●● The brachialis muscle is carried medially, protecting the cutaneous branch of the musculocutane- ous nerve and exposing the humeral shaft. ●● The humeral shaft is identified and brachialis muscle is elevated with a periosteal elevator. The radial nerve is protected and retracted laterally. ●● The humeral shaft may be exposed by sharp dissection proximally to the lateral origin of the brachialis muscle on the humerus, which is confluent with the deltoid attachment distally (Fig. 1A-6A and B). ●● Both attachments may be released allowing complete access to the entire proximal two-thirds of the humeral shaft (Fig. 1A-6C).
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