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2.
b.
Along the line of the clavicle and down the lateral aspect of the arm
c.
Reflect the skin and superficial fascia laterally from the front of the chest. Look for
a.
b.
The lateral cutaneous nerves which emerge from the intercostal spaces beside the
sternum and in the mid-axillary
line respectively.
3.
d. Medial cutaneous nerve of the forearm (emerges with the basilic vein on the medial
side just above the elbow)
e. Lateral cutaneous nerve of the forearm (emerges in front of the elbow, lateral to
biceps.
5.
Carefully reflect the skin from the floor of the axilla (armpit), but do not disturb the
On the side of the chest, expose parts of serratus anterior and try to preserve the long
DISSECTION GUIDE:
This dissection will take considerable time and patience, and it is easiest to follow structures
seen emerging from or entering the axilla. It is not possible to clean and preserve the
structures in the axilla properly in one or two sessions and one dissector will need to continue
with this part while the others continue more distally
1.
Detach pectoralis major from its sternocostal attachment and begin to reflect it laterally
and note the medial pectoral nerves piercing pectoralis minor and supplying the sternal head
of pectoralis major.
2.
Carefully detach pectoralis major from the clavicle; avoid damaging the lateral pectoral
nerve and the thoracoacromial artery which divides into pectoral, clavicular, deltoid and
acromial branches, just below the clavicle.
3.
5.
Coracobrachialis and the short head of biceps arising from the coracoid process
b)
Axillary artery; and the beginnings of the median and musculocutaneous nerves
c)
Ulnar nerve and medial cutaneous nerves of arm and forearm (the medial
cutaneous nerve of the arm is frequently joined by the intercostobrachial nerve
from the 2nd intercostal space)
d)
The lateral thoracic artery and the long thoracic nerve, which descend on the
serratus anterior muscle.
Axillary nerve, passing posteriorly with the posterior circumflex humeral vessels
b)
Upper and lower subscapular nerves trace them to teres major and subscapularis
c)
The thoracodorsal nerve and the subscapular artery trace it to the latissimus
dorsi
d)
The radial nerve; trace it in to the arm for a short distance and find its early
branches (posterior cutaneous nerve of the arm and muscular branches to the long
and medial heads of triceps).
7. Use bone shears or a vibrating saw to cut the clavicle in to thirds so that middle third can
be removed. Expose and clean the roots and trunks and divisions of the brachial plexus.
Preserve their branches:
8.
a.
b.
c.
d.
Open the deep fascia on the medial side of the arm and clean and follow the brachial
artery, median and ulnar nerves, and the medial cutaneous nerve of the forearm. Note that the
ulnar nerve pierces the medial intermuscular septum to pass behind the elbow, while the
median nerve and the brachial artery pass into the cubital fossa in front of the elbow.
9.
Remove the deep fascia from the remainder of the arm and clean corachobrachialis and
the short head of biceps and find the musculocutaneous nerve, pull these medially and find
the long
head of
biceps.
Make skin incisions (keep these as shallow as possible but note the skin of the back is
quite thick):
a.
b.
c.
d.
Laterally, from the middle of the midline incision across the posterior axillary fold
to the arm
2. Reflect the skin and superficial fascia from the back to expose and clean the surface of
latissimus dorsi and trapezius. Look for posterior cutaneous neurovascular bundles
beside the midline.
3. On the back of the shoulder clean the surfaces of the deltoid, infraspinatus, teres minor
and teres major muscles.
4. Reflect the skin and superficial fascia from the back of the neck to complete the exposure
of the trapezius muscle.
5. Reflect the remaining piece of skin from the lower part of the posterior triangle of the
neck.
6. Detach the trapezius muscle from the occipital bone and the spinous processes of cervical
and thoracic vertebrae. Reflect it laterally and identify the accessory nerve on its deep
surface.
7. Clean the rhomboids and levator scapulae
muscles.
8. Detach the latissimus dorsi muscle from the
thoracolumbar facsia and reflect it
laterally. Confirm your identification of
the thoracodorsal nerve.
9. Identify the teres major muscle and find its
nerve supply (subscapular nerve).
10. Detach the deltoid muscle from the spine of
the scapula and the acromion process.
Reflect it laterally and find the axillary
nerve and circumflex scapular vessels in
the quadrangular space.
11. Identify the supraspinatus muscle and remove the subacromial bursa to follow its tendon
to the greater tubercle of the shoulder.
b.
c.
2.
heads of triceps.
3.
DISSECTION GUIDE: THE FOREARM AND HAND (with the cadaver in the prone
position)
1.
Make skin incisions (keep them very shallow) down the medial and lateral borders of
the forearm. Be aware that the cadavers forearms are pronated so the ventral aspect of the
forearm is exposed
2.
Reflect the skin and superficial fascia from the front of the forearm but leave the deep
fascia in place.
3.
4.
b.
c.
5.
6.
a.
b.
c.
Palmaris longus
d.
e.
Pronator teres
Remove the skin and the dense lobulated fat from the palm of the hand and expose the
palmar aponeurosis.
8.
9.
10.
Brachioradialis
b.
c.
Extensor digitorum
d.
e.
Extensor indicis
b.
c.
d.
9. Clean these tendons and locate the anatomical snuffbox at the base of the thumb in the
snuffbox you should be able to find the radial artery, trace it backwards into continuity with
the radial artery where you found it on the front of the wrist. Trace the radial artery distally to
where it pierces the first dorsal interosseous muscle in the web between thumb and index
finger.
10. Trace the extensor digitorum tendons to the fingers and
identify the extensor expansion on the back of at least one finger.
Note also that the 4 tendons are connected to each other on the
back of the hand (tendinous interconections).
DISSECTION GUIDE:
HAND
1. Carefully spread the gap between the flex carpi ulnaris and brachioradialis muscles and
identify the 3 deep muscles:
a.
b.
c.
Pronator quadratus
d.
Also trace the median nerve, the radial artery and the superficial branch of the
radial nerve through the forearm.
2. You can detach flexor digitorum superficialis from its radial origin to get a clearer view
of the deeper structures in the forearm (especially find and follow the ulna nerve and artery)
3. Identify the supinator muscle and the deep branch of the radial nerve.
4. Look again at the palmar aponeurosis. Distally it divides into slips (one to each finger).
Between these slips look for common palmar digital nerves and vessels dividing into proper
palmar digital nerves and vessels. Remove the skin from at least one finger and confirm that
each finger has four cutaneous nerves (two dorsal and two palmar).
5. Cut the palmaris longus tendon and use it to help reflect the palmar aponeurosis distally.
Note how firmly it is attached to the fibrous flexor sheaths of the long tendons to the fingers.
6. Under palmar aponeurosis you will see the superficial palmar arch. Trace it to the ulnar
artery medially and radial
artery laterally. Also
identify the common palmar
digital branches.
7. Also in this part of the
hand you should follow the
branches of the ulnar and
median nerves, and verify
that the median nerve goes
through the carpal tunnel
and that the ulna nerve goes
over the top of the flexor
retinaculum.
8. Locate the recurrent branch of the median nerve that supplies the thenar muscles.
9. Locate the deep branch of the ulnar nerve that goes deep into the palm and supplies most
of the small muscles of the hand.
10. Deep to the nerves and vessels in the palm of the hand identify the long tendons to the
fingers and the lumbrical muscles arising from the tendons of flexor digitorum profundus.
11. Follow the lumbrical muscles to the extensor expansion of each finger.
12. Open one of the fibrous flexor sheaths down the front of one finger and lift the two
tendons out. Note how the superficial flexor tendon splits to allow the deep tendon to pass
through to the distal phalanx.