Upper extremity vascular injuries

Question 1

Describe the incision that can be made to expose any vascular injury of the upper extremity w/ the exception of the ulnar artery?

Answer 1

-starts on superior edge of sternal notch
-runs laterally on superior aspect of calvicle
-crosses mid-clavicle to inferior clavicular border
-traces deltoperctoral groove
-curves medial to trace the bicipital groove
-crosses elbow obliquely
-runs on radial side of volar forearm to wrist

Question 2

Where does the subclavian artery become the axillary artery?

Answer 2

as it crosses the first rib

Question 3

What is the course of the axillary artery?

Answer 3

runs under pectoralis major and minor

Question 4

Where does the axillary artery become the brachial artery?

Answer 4

as it crosses the lower border of the teres major

Question 5

What is the location of the axillary vein in relation to the axillary artery?

Answer 5

the vein runs inferiorly and superficial to the artery

Question 6

What structure is used to divide the axillary artery into its 3 sections?

Answer 6

pectoralis minor

Question 7

What is the first branch of the axillary artery?

Answer 7

superior thoracic artery
-from the 1st portion of the axillary artery
-originates proximal to the outer border of the anterior scalene muscle
-supplies pectoral muscles

Question 8

How many branches originate from the second portion of the axillary artery?

Answer 8

2 branches
-thoracoacromial
-has 4 branches: clavicular, acroamial, deltoid, pectoral
-lateral thoracic
-travels inferomedially along inferior margin of pectoralis minor
-supplies the serratus anterior

Question 9

What are the branches of the 3rd part of the axillary artery?

Answer 9

-anterior circumflex humeral
-posterior circumflex humeral
-subscapular
-largest branch of axillary artery
-origin of the thoracodorsal artery (supplies latissimus dorsi)

Question 10

What incision is used to expose the axillary artery?

Answer 10

-starting at inferior edge of center of clavicle
-runs laterally in deltopectoral groove
-if time allows retract or split the pectoralis muscle that overlie the axillary artery, if no time cut it 2cm from humeral insertion

Question 11

Where do the median and ulnar nerves lie in relation to the brachial artery?

Answer 11

proximally
-median nerve is anterior
-ulnar nerve is posterior
half way down upper arm
-medial nerve crosses the artery and runs along the inferior-medial (ulnar) side of the artery

Question 12

Where does the brachial artery run in the upper arm?

Answer 12

between the bicep and tricep in the medial arm

Question 13

Where is the incision placed to access the brachial artery? Its bifurcation?

Answer 13

in the groove between the bicep and tricep muscles, extend this obliquely across the antecubital fossa in a lateral direction to expose the bifurcation and proximal radial and ulnar arteries

Question 14

If dissection of the brachial artery is carried out below the biceps/triceps groove which nerve can be found and mistaken for the median nerve?

Answer 14

ulnar

Question 15

If dissection of the brachial artery is carried out above the biceps/triceps groove which nerve can be found and mistaken for the median nerve?

Answer 15

radial

Question 16

Which forearm vessel is typically the dominant vessel to the hand?

Answer 16

ulnar artery

Question 17

Where should an incision be placed to expose the radial artery?

Answer 17

radial side of volar forearm along the inferior and medial border of the brachioradialis muscle

Question 18

In what fat pad is the ulnar neurovascular bundle typically found?

Answer 18

fat pad between the flexor digitorum superficialis and flexor carpi ulnaris muscles

Question 19

Which muscle does the ulnar artery sit on top of?

Answer 19

flexor digitorum profundus