4. Axilla NB notes.pdf

Lecture: Axilla Prof Nanette Briers [email protected] Room 4015, Level 4, Tygerberg Campus Outcomes  Define the axilla  Identify the borders: apex, base, anterior border, posterior border, medial border and lateral border of the axilla  Identify the contents...

Lecture: Axilla Prof Nanette Briers [email protected] Room 4015, Level 4, Tygerberg Campus Outcomes  Define the axilla  Identify the borders: apex, base, anterior border, posterior border, medial border and lateral border of the axilla  Identify the contents of the axilla  Identify the origin, course, branches and supply area of the axillary artery  Identify the origin, tributaries and termination of the axillary vein  Lymphatic drainage and nodes  Understand the implication when contents of the axilla are injured / ligated Axilla  Structures enter superiorly from root of neck  Exit:  Anteriorly to pectoral region  Inferiorly & laterally to upper limb  Posteriorly to scapula  Inferiorly & medially to thoracic wall:  Serratus anterior &  Latissimus dorsi Axilla  Location: Between arm and thorax, inf. to glenohumeral joint  Passageway for neurovascular structures between neck and arm  Structure – pyramidal shape  Contains lymph nodes  Importance: Breast cancer Contents: Lymph nodes  Axillary lymph nodes  Receive all lymph upper limb and portions of thoracic wall, especially breast  Arranged in 5 groups  Drains to supraclavicular nodes 5 Borders  Apex  1st rib, clavicle & superior border of scapula  Base  Skin & axillary fascia (armpit)  Axilla: Borders…1 Apex: 1st rib Lateral wall: Clavicle Humerus Superior border of scapula Medial wall Ribs 1- 4 (5) Intercostal mm Serratus anterior Axilla: Anterior & Posterior walls Anterior wall: Pectoralis major & minor Breast Posterior wall: Scapula Subscapularis Teres major & latissimus dorsi Posterior axillary fold  Axilla: Cross-section Anterior: Pectoralis major Pectoralis minor Brachial plexus Content: Axillary a & v, abrachial Axillary &v Medial: plexus Ribs 1- 4 (5) Lateral: Serratus Humerus anterior Scapula Posterior: Subscapularis Axilla  Process of Spence  Or axillary tail  Enters into the axilla Axillary artery Location: Axillary sheath Thin fascial sheath Extension of prevertebral fascia Encloses axillary artery and vein and cords and branches brachial plexus  Part 1: – from lateral border of 1st rib to medial border of pectoralis minor – 1 branch Superior thoracic 1 artery 2 3  Part 2:  Part 3: – Posterior to pectoralis minor – Lateral border of – 2 branches pectoralis minor to inferior border of teres major Thoraco-acromial artery – 3 branches – Pectoral, clavicular, acromial & deltoid Subscapular artery branches Anterior circumflex Lateral thoracic artery humeral artery – Supplies the breast Posterior circumflex humeral artery  1 2 3  Many branches  Connections between main arteries  Anastomosis around shoulder  To ensure alternative route to supply UL in case of disruption Axillary artery termination Axillary artery becomes the brachial artery at teres major  brachial pulse  Axillary vein All regions: superficial and deep drainage Lymph vessels associated with veins Axillary vein Cephalic vein Superficial venous network: Dorsum Palmar Highly variable Basilic vein No constant veins Median cubital vein Becomes more constant at Shape varies: H, N, W cubital fossa  Axillary vein Subclavian vein Cephalic vein Axillary vein  Continuation of basilic vein  Continues as subclavian vein Basilic vein from lateral border of 1st rib