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Operative surgery-2-Upper-extremity

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Upper extremity

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Operative surgery-2-Upper-extremity

  1. 1. I «I ‘ ll II E . he I ll 3' fr? Pr Cfik. , ;-_. A '17?)/ iiigrziplr flip ujupi .1 . , '“; ,*ni ‘kt’ -: .i*fi‘. "u'Ii' “lru; ,'i'_z»’r’. 5., _A& . " ‘:4 lab §§€>Ufiq ¢J_. ..5‘0 U‘. . ‘J . -, (,4 .1 . ;r . i -V- '. rxf‘ : L. Smilie ""’lu! II. l.[I[L>’I“‘iftlrillfo H l ii’/ (Iris 5 ~ II If ;5'(}]): ~r(iiii2ir. i ‘I‘I’I'L‘[I‘1((fI‘IIg ‘fl Iii)! /mfiiltimi irgrtll 21:‘ wrlitiiu/ III"('iIIi ” ii/ ',_I/ ii‘ ~11; : ‘4»'u_. s.~. 'g{i , "m_'rr'}', ‘- ii'ritl. .It' _g': ‘-€76 ,4.-iI—‘‘Ir‘‘ ‘” V-~ £7" . -I I rfiifiiirrfiii ii‘nrl III, ‘ Illlf fé’_; lf‘III, J. rI'i'IzIr_'r' ‘I"IV’: ',"llV'(_)'ll, ~"t'A/ L‘ f-I(": I_'_? Vl‘. ]ur¢’rriin. /mm mid jiiig-e'r. s; w I II '“ <:17«: .-»v_ -. _ _V , _A-‘. _ , - "3, Cf. _ 2‘ivlin, g= fofpJ: r:i(¢ir1'; rriaz- ’. '$P$' and pI'n’e, r:nm X if iii}/ ii7z; i"Ir: ir: _i*“r; _), I I-‘it. -(. ’i‘: V/: {)'lall’l‘ .3, F, I oz, -., fi'~,5” ‘ H_ to 9 {I g , ac. - . ~- «-67 n"ris! jm'liI, ‘. _). ,."L‘, g. . ._ iip}iE’r z’. i’fr’eIi ‘"75 . ll. U » slurry "Ilia; ir}i'; )¢? ri° r». ij‘r_i‘w_: ir’r; I’ I) , .= 3.-. %;»_ . ill ’. .W’. '.. I JW""‘ ii hum‘ r'c; ,m»ii. sills: -Imjzriilr ‘region, - e. i-i're'ni'irr_i: .- ip. .'r_ erx(rm: rii‘_if: .mr~it'*iIl nriIr_ri/ »_: ilc{Ii'i4'Ii_3 >11)’-ljlvllvbivp . I i #1 III F. . j l 'Ji_ . .
  2. 2. T( ). P()(’IR. »l’liY OF THE L-"l’l’F. ‘R EX'i‘Rl7.IV‘llT’ (I:7XTRE. l'i'lflT4S SUPERIOR) llirc LI}flp‘c‘I'c‘. lI'CI'Ill'[__£ is tlividccl into the I1,Ill«mli‘ig I‘L‘; _;IL¥ilb. . ‘Scaprrlz‘ii' mgiori (regic) SL1!/ .’1(/ (r‘l"I. ) Dcltcicl Icgitrii (i'i. '_git2 u’cz’IiJ; «.'i’i: t;) li‘il'rtrclzi'icI. ilzIi‘ iwggiirri (iw: j,<. ;.I’. v‘. I iii, ’/‘ii-Ii‘i. ;I‘iL'u1ui‘i«-I . »-’l'lll(-II‘) i‘I; -jgicm (i: _'jgsr'. I . ::-. ‘i'. I’; ’I. .-'r. I'. ~ ‘I AiitI. :ri'oi' arid j}U‘SlC’I‘I{¥I' i'cgi: _wrrs oi" the £‘ii'lIJ I: .Iv}1.-"r'r . ‘:m; '!i. =/ .3. / ll! /'Ii<’! ‘i L1}lIt’l‘. "(l! ' er / _>r)S‘ft*I"i"</ I‘) Anterior‘ and pi. .Istci‘II. Ii' clbc- i’cg, ioIis l. ’HL'; |‘g"i; (,-’ tuI'. >[Ii Ulric? !‘/ Ail)" cl / m.m: 'r1'. :.I/ ‘) , -.= ntci‘ior and pC}. ".xl‘: I'luI‘ l'CgIOll*‘i of tlic l7;rr'cai'in (reg/ i-. » (mfg/ rim"/ zii uiz/ .-. -vim‘ er _; .I: >.‘~i‘t~I'. 'r. «i“) ‘i‘I<. t l't"t§l0l1 (f'L”‘<. ,"I'{_) irc1rpi') l’alni; Ir and dorsal rcagioiis of the huiid (mgtziii pa/ imw er ilursi ilI(1Ili‘: ‘5) TOPOGRAPHY OF THE SCAl’UL/ ~R REGION (REGIO SCAPL-*'[. ARIS) A) Lalldlll21T. lS§ A. cmmion Stiperior angle olllic scziptilzi li1t1:rioi' cin: _‘: _le oftlic . '~7r3EIptIltl B) Boi'tleis: Sii. ji>ci‘ioi': HLIi‘§z<; iII3l lint‘ LlI'ii‘flflITI. %I_If; l‘r ilk‘1iL'F<f‘-II7l(‘I‘lldllllc lcxel ofhtlie 7” C€i‘*ical '€I‘l(ib1"; I) liilcrior: l-lt. Ii‘i. I_oii? .:. il léric dI‘. i'»ii Ilri . _= Latcrzll; Vt: r‘Iic: .'il line drzixx 5: it . /lctiizil: Medial in: -II: <_1in sftlic §: ij. rj3l. .iILI Iii: Iiiiui‘§iJr ziiigic v. >2'"tl“. -c 5L£. tpLIla Iii. Lt. l'UITIrt'-I‘: C) l-a_jcr~3: Skin: i. It is thick with limited m0‘L’IYI€IIE. ii. If is inm-r'vated by the ziupcrior l.1tc-ral cutaricous I1CI't3 oftlre arm (lateral SUpI“3ClaVlCIIlaI" nerve, dmrsal . -'~. m:: or ilk" uppcr tlxoracic ncrvaz). $ri'o«: uta. iu: oti5 tisstre Strperlicial fascia: i. It is dense and consists ofmany layers. j 7 . __
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  4. 4. gdial: Lixgfe c()n‘i1;: ctVing margin offigie p£: ctLjra1is majdrggdLT1»a: iss; ‘m; ;s_ dgyrsi l §1Ll§aéS the sagjgal section of themlatcral surface _Ofth€‘Il1QX'a{2§, _flt me level ofth; 3%‘ rim ‘J, ¢,. ,ateI‘al: Line con'nee1'ing the mar'g. _7,in of " upiejitoralis II]r«’: ‘1j“(V41l"iLi}}§l Ii}/ IyiSSigT_‘1_. tlS. .d'Q1‘Si{}} fhusglcs on the ng§: di§l surface o_f1heV ‘ V N j. Ft is thin and newly. n1o. v:able. ii, ltcontains lots of'Vsw'eat_g}ands, sefiacecusiglands ; md. h,air. ;jii. L!t isdjt-11;1cLriz, a,t, ;:d, ,;V1,,3}’ intercnmtobrax: hVi; ;»lV,1y3rvg; . «E§dbciLItar1¢ous tissue; V M : i.. It céntains siiperficial z1xiI! a“r‘y l, §-‘nffih nodes. (:35, lL, i:: gifi}!3€~Z,13 yggdftqyL1Lzefiu; :s; custalfne: sa: &qt‘the media} Q; ‘J; ::'§—u. ;' *‘L), eep ifééisciii (; axiVITat‘y fésc-ia): It cjqh_tai. ns nerve a?1_f_d. V'€f§SéI§. ‘ii: ItflintaizisEthe. .susp6niSit21*y Iigafn'§nt5Df1h€3“3Xill3- igiii. l; ',‘SCpfi{£it8$ ; é1ri“cl"'1‘brri?1Vs‘the pec"iox‘al—fascia ‘ameriorléy, ’ 11 nit}: f¥7}é‘Cfi§3i‘: ibfi‘s 1fi‘aj€f ifiiifiéic vVfi?13"§”tlavipectQraz! V fasciaa » ws‘fe”ricSTr: L: i§u1‘ii‘r_i 51 ‘T9 t’37s‘sVi: nus dorsi. tents minor and ‘tarts nmjoj. *mT’1" K f‘MeA_dia1: 'T}1f§rfitic*W; %illi. _s: en'au2s*ar1terio. rmusdc and 1“ u:1ti!4“‘ intercostal x1_, m5{: §1E§ - : L,a. t¢1‘a1: Sjurgiéaij Wk of 111:9: hu. n1r? ,1'us— shsm %z¢; xdVs; .£. TI?11:s: ; ? .;i. s;5:n, .;a‘ vs= V=9r@: ;s2Lbra9il: ,i€%! ;i: >12;uS9J§ "V ( 9‘, -V tA: _gi_L]Vla1'y artery is divided j_mo3 pans and g_f1; .cs bram. 'h; :: according to: i. Iflavipectoral triangle: T’hoiaco; ;;; r0mfiaI a3'{§f}: €1f(é'! ‘f(I fhqrficicaéj iateral and medial pectarai n: :;r“V’: :'si A fii. Pectoral triangle: Lateral thoracic ancr} a1,11gL1Q11g : l;Q<: a1V, ;;j&Q, ;;g,1:yige : iiii~«. §LL! l?P¢: C.Ioral triaflgigl . §;;3;:2¢: s19t1l<2r nr9¢r>_+ humeral arteries Axillar}! vein , c”hia'l plexus: T= §i. . gLatcral (cord: ¢ J1. ; Poste1'i, ;;>r cqrdé —~-— 119
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  7. 7. 4‘ 1‘. "f‘. ’;xU. ‘ 1'“f¥‘. ‘flI . - i: nz11:. ",‘ . "—’U"'i, _ pa ,3», -U ‘G F “ ; ‘i': [.; q’, n_v §~, —_1_-1 ff-K D5,‘; -fg"1'g; ';I{—. m§: ;._: »1'_m1‘. -»L'k H} . ‘l'l‘n' H‘; '. i;: >!'1;ii!1i‘Ii'tg‘Ln}. i" 1 'w‘. ..i. ..5.$ Kb: :n‘1:‘1‘. is 9 ) ' L’ V J * 5 ’ ‘W -; H 0 IL'‘_. 3.“ . ’;. M5‘ ”‘ ' I = .“ 1:‘ ‘ —' . 7. L‘«. "". -W ' 1. " wmcxyy. gm. n-. -ups . mu~ dIH. IHll['.1L' '. r.. '.1uc: c1.»~u. >n. .1: d! .1lu. »é= ui.1«: -.m » ‘ _ ' ‘ / ~> , _.z. _‘ , . ‘ . - -- , r~. /_u " ‘ ‘ . '~; w,<''‘; arr: ::, ’ ‘ ’ -° - “ afl ; ;._w . :_~. . V ' ‘V ’ Eb R , , "Kr , , , _. "f«= '3”~ 4 -onr‘—‘ .7 ; ~, ='l -. e-an U : l‘0I‘. 't‘)(? R.xl’! ! UP rnr. sL! B<;1.. ’LNRu; u)x 1 In K 1. 1/: .S'r “w = ’*- >--7 ~v ‘ _x; ~ . K - , A ‘ : ’. ~_1 ’ 2. : ti'i~ :11 . >‘, ' guilgt‘ we £x.11’; 'a. "I. :g‘: ¢1‘{Z. ;sa’ : g‘1_. -'1-. mfM V '4 I‘ V1’? :93 ‘V(, k‘. ~f’% -/5x/ w, V. D E ‘ Q’ . § ". lIL7»1Il‘1‘. ;1I’Lx"v M w, , , J" A “'iL‘. 'H. ill: £ H . _‘. A'n : ::fi: >». a.n. m»°”‘ , , ‘ 1“ H ‘ A’: ‘ . 1 *5 ! ,f'. x.. =:. or. ;i: 1:11’! -Iiflvrania-. §L‘ L_ : .:-. %l. T”. l{[': "}‘r : ‘?')LI~, ck ” u I "E 25- 0 . " G ; I V. . 0%". F . up-; rw: .khwclc: ' ’ u = H”, ‘. yaw u‘_ . I / ¢. ... .n. ~ « / “ . - '- :1 L’. "V ““ ‘‘.5%j-1c3I1’11‘‘H1>I‘! ,{na: :;! jvM| c : ,s[al1‘lhIu= .l'-. “F ‘ U x_". .,; <’T. « 4 3.‘, " J ~. r U“ R m'. mmm'jx ; .;}. n1d; m= :1m; :o; - U , 7 F2 3 V. ‘ “ »_. ', ‘ _ H . “ H .4 ‘, ' I - -; ‘vbsdml 1.41;-":1!m.1:‘; :=': u. ihz: ,~'1u-: ;:um. - CH ‘ , .é_, , ‘ —. ‘vV ‘ ‘ . ' 5|; . L,xtu‘g13 . -I1!u= ;.»rzn. u'-_'m utflm z{«: li; _' H1; r‘v. vq. -J. W D . , ‘V; _ 61? Ihill. "‘‘i{‘x”"‘ il"-JR . lh: s‘‘ : : It s; nnI. :‘: ,n. < ~«: ;haccm.1.~, -. s?; »:: d.~. A ’ M , ,_ J ’ N; _, “L Kéii Hm» _imr. r Med ‘. ‘_l§1L’>§-1iI-‘T1‘C{lVi‘- ». :(x1;u- aw-‘1 L“: '. vrrn‘r. '. ".5 _: .DrD. D '6, Jbw iV: «_> v, ,; . ,. ’ “ K > I "V W’: I J R ‘ ‘ J we {LK T‘~’1:f~'»‘1"'; i"? a%. ‘:. i‘i~ Iiiilii. ’ J H . V‘ ‘ L -, . . ~ L , 9. ' 2:“ =1 -' .9 ‘ s= M. -o-J; sxsm Hxdu -. <'Ia. :;tr. ~J. c*. ~;. »;= .‘1:1l: _ 4:2: -m_mcfi . r ‘ v‘”: “ 3; "II A»-, u'ili1ii| .~ Ur; cumtm p-.11;-~: '.‘~c‘_ rL: A-3"; L ‘ _t. W “’ flie- «. cT; z11. it : :'mn: un< thc $hur'; :cn; .«. u‘nnml . -mu ti . i.‘! L‘{H‘_3Lx! l'l. ‘ . ».'. — mrf’ “—j~u_. ;!2.¢: }:» 3.11:‘, .r-. ,slIm‘~. M. -1“ . r‘E; . -—_~_, _ '——. ‘;_. _V . | «-3 - uh‘ %" ' ' ‘ ‘ !1l'; "r, x.-: ‘.. r1.ssgm u"’.3 ajw 330 "5 U ' 'i ' ¢f‘1n: cs{~- t;3'_ ’i: ;; rfl . .~ , , ‘ ' 3-6:? ‘ I B: ‘ J fl‘ N O“ ‘(L-‘ , U‘ M fa . ‘, up (1 ‘
  8. 8. i, It covers the pectoralis ntajor muscle. ii. lt divicles the pcctoralis major muscle into 3 parts: — C; 'lax-‘ictrlar — Sternocostzrl — A hdom inal iii. Borders: — Superior: Clnvlcle - lnfeI'i0r: Fascia ofthc serrattrs anterior and recurs &l‘»ClOII1ll1lS muscles - Medial: Sternum — Lateral: Deltoicl and z—r>: illarj_ ‘fas<. ‘.i. ac> Proper fasc. ia (clax. -'ipu; :t0ral fascia): i. It is attzlched to the lmwr margin ofthc Cla"lCl'c, C0l'£lCOl'; lpI‘L1u€SS and 1*‘ rib. ii. It covers ‘tllc . ~,u'L>-clcrx ius anal p-; ;ctm'alix: minor muscles. iii. Lower part olproper fascia forms the srtspensnry ligaments ofthc mammary gland. TOPOGRAPHY OF THE ANTERIOR REGION OF THE ARM (REGIO BRACHII ANTERIOR) It is also called as anterior brachial region. A) l_andmarl: s: B) Bord Delroid muscle Pectoralls rnajor rrttrscle l. .atissi: nu>: rlorsi muscle Bicep; < ljraclrli nuts: 9 'l riceps 'b1‘acltii muscle Medial and l al 6;: -is (jrczrter lul*rcr: lu sit’ .9‘: //Ci bici/ .2i! :1/5.5‘ fa’: dict‘; «. ;=ncl_ lC5 ’; »l‘t'; t'c ‘nurncrus l 212: n. L:rnr. r*" Zucar. ’ ers: Superior: Horizontal line dr3‘n [s‘(= =*t I lnlhwior: Imaginary line clraxm xx £15 I E of the humerus Medial and lateral: Vertical liz: -.~: ~. _lr: r-. '»n IXBE1 rnsclinl aml lateral epicondyles ofthe humerus respectively he p: -ctoral is nvafgor and latissimus dorsi nmscles ‘rzgcrrs efooxrc the lat": -r’al and medial epicondyles C} Layers: Skin: i. lateral is thicker than the rnetllal one. It is slightly movable. ii. 11 is inns-r~'ated by the medial cutaneous nerve ofthc arm, lateral cutaneous nerve at‘ the arm, superior lateral cutzmaous nerve of the arm and inferior lzrteml cutzmeous nerve of ‘rh: arm. ‘-15 L. )
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  12. 12. ,; ;ij; t:; e pl;1cgm<. i)iiis. ;lin. ci. i}; §jit2i1i 1‘9§sa, if 6i‘tI)¢r{irL%"u: ¢'1’ awn to the “-‘rfisfjgiirifoiil iiip lb the azggillary region. ,Frcimthe, axi1Lar, V1‘egion, it rpay pa:3s. .vtg, thc s; cgpulaf. l.regi<lm, , then to, ,the*post comparfinent oftligz irppcr arm. Tlieijn, it péisisels along the p‘; L’ ' i? .tDi'tli€ist1bc1aViani regionland ti_ip_r3c. ic cavity. it m: —ylpa§_s ti) We subpeéiorali §S’fic€ i§£ivl‘C)! ‘1i$M_. *;iVlil’l€ branches offhieiaxillé? “§z'il. a”i‘i€§y, A; ;.last_, , Ltftéfachiéfs. Iiicgintagzidriiifiiiialstimriii ? ?‘l“€S11/lting lI1jigI1t; ¢!lFlOT‘Yfl‘l€ClLl: ‘ ‘llfilIl, $j ii i if the phiegindn is in th¢: axil. lar§filreg3iqfi, ph‘s’_s; ;clow‘n‘ti3 'il1’V<-Acubitial fogsgi or Postmior regidn of the UPP€c_1’? F.m ; €li; Ql}g, the Q1f. ?1§gl¥l§llii, ii3L; £§§}il1lllZQ}$§B: e1lL§; *l11“1¢1'l. ?J11ll$°Uli? T‘Cfinills Phlegmon in thfi thumb 6:I': lliliCll€, vE‘l? lil‘l'gél" ieiiohg the iiliiar and radial il5fi‘isé§tE”3fV thefPirog0v’s §pace in tlie fo1~eaifin. From there itfpas$es up to lhQ'ClJil, J_ll&llA, ,lQS; §a ; pIhs2r 1‘f'. ~’. ‘:’-R2333l§$. .m€Il§l0?1€%di this . tiaiib: ii_i: i’a: :is. i:r; éfi‘el, ‘. ;15Tp1sioNs (JF If tl1_eiphlegnigi17'i; in the am-crier COlTipE1Efi1J€_Ilt: i"VDl; :. Ili£}CaI1Ii. i11Qi3ign; ':; §a1:§; 'in}1d§§ filiongi1he, .l£iI¢r£1l. and medial tio‘r_g1g; %rs of the bicgps bfaciliiiii imiséle; if it 'is”i’r‘ithe‘5; iigfgostcitioi‘ Cy0I]1[13.lC3;lTl€I'll’. , of Il1,B,31fTD, l‘21Il incision» algng 1_he; bord_er of ]', _l1€ , t1‘l{; :§3_. })S, ll3,T_L<f§5_Ig‘l‘il: i_? . jiiiisclé iS‘, lhilC, l:L: ’. Elf the phlcgmnn is in the axillary réigiiffi, an ifiéisidiimlias toibein ade. p03lél'lQ_ff6:fFl¥é: € i‘i'f5i'OjeCTl0l1.llI1fl. ,Qfvfl1€ a2:'il, l,ar§I. £zt§‘: .ry‘; Aft/ er cutti'ng<the<skin, the tliS$€Cti0TTj'{! f thgii = gissu_e must be cdntiriued by bl‘i’inLway (such aS_l,1Sl_l'lg. fDI? Q6pS; ;Oi2»fll)gBI'). Iitjs don 3115.0 ts». prevent damage the braQhialé2l£2‘$! %L$ am bra. §!i9l; sSi of iiwfhith £1l'€'JOCEllLC»d, . i_ii.1lie axillary region. M _ M H glfthe ph legmon is located in this dialtaidi regi.0n». »amiincisit3ix1i. ii, S~12¢1:fQ. J§: i‘i’eiiiL£I anterior bgrdgr Oftlieidel; p‘idjniiI'$élE. Tfii§: aangéfDi1i§ilbiffiiflréi “it . élaorder be. ’c: :§iis§e"t}i‘e axi l.1.fi1i‘, *i‘TI.1;’c. I‘i; ~‘lei is. Igigaféd ‘iii§zi; ,to_ iL_T_}l'tf; ¢; t}_§§, l_l}g‘i1f.1;jil$‘Ij_§; j‘ fie. ii} f§>. k57.§tl1‘iéitlé71l<>i id‘ii?1"7i¥S-C3&«TT lbng ; i.2;£1£;1§1si:3:;1i0;; si >: l«‘»ilIaE'§iES. ;liQE x? i:js, S[. i:Ls. i; §}. ,”)‘: A3w><gAillar;4; ar_t§_: ry (_cu'1‘€: j‘1fa c:1.*. "/! urI'5). ’~ Lilt passers l.5,v‘Q§}1;£j‘.7lL)})g ii); giizgriqr #11121‘-5ll». Q.fTll€ i; i;xillai_‘Viifiséai»(; i§'i[¢ie. ‘;iig: )’i1'fir. is? [g), r.c. sient). i’= ;ii igiiggiiizli arffcr}-’ (arm-a i+; ~m%Iis2z; i;_<: ii: i ilt passésifromithe. axi11ary fosfisfaiioi the midpoint hefxx-‘sen the medigl epi§ondyW1g_gfi: gghe l_}Ull1€IT}.1S4Em(_lI_8l’ldO!1S of biceps brzicliii {§[, l,, l.lS$», l€, Radial artery’ (urteria radium"): ii gilt passes fronn {lie medial margiii ofthe tend0n. of1,thelbicéps, ,braghiil'muscl ‘midpoint of the ciib_litaliifossa tlie pilllsfiilfilliiilKpiélfiif/ f6i'%ll1€: ;pnOTfiEE§ifi‘G?3;g}j1'il3£8iIfall}~l lgifibim»-‘lib~S¥: g§lQidV; P‘1;5i39SS. .0.f‘tlT6:Tfll£liU5) of they raidialiiilarxery: V L Di lllnizir artery (arteria z. tlri: iriS): :: iI»ipassssT'rorn»tt1;¢ 1Jli§€1i€11vs@i%9«L1é3l§‘l§ of the: hximgrus to the;1ats>; ;l. xn: ;;g, iii. .<2i, fi L ; __ 2,7 . __
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