Regional Anatomy

1. Regional Anatomy Ling Shucai

2. （Regional Anatomy） 局部解剖学 ① Head ② Neck ③ Thorax ④ Abdomen ⑤ Pelvis ⑥ Limbs ⑦ Back ⑧ Vertebral region 头部 颈部 胸部 腹部 盆部 四肢 背部 脊柱区

3. Regional anatomy of upper limb The pectoral region and axillary region Ling Shucai

4. Ⅰ. The pectoral region

5. 1. Surface anatomy 表面解剖 2. The superficial structures 浅层结构 Superficial veins 浅静脉 Superficial lymph vessels 浅淋巴管 Cutaneous nerves 皮神经 3. The deep structures 深层结构 The deep fascia 深筋膜 The muscles 肌肉 The vessels 血管 The nerves 神经 4. Regional anatomy 局部解剖 The breast (mamma) 乳房 The clavipectoral fascia 锁胸筋膜 Main contents

6. 1. Surface anatomy

7. 剑 肋 角

8. Skin incisions

9. 2. The superficial structures

10. Superficial Structures • The cutaneous nerves皮神经 • The superficial blood vessels 浅血管 • The superficial lymphatic vessels 浅淋巴管 • The breast 乳房

11. Cephalic v. Lateral cutaneous branch Anterior cutaneous branch

13. 3. The deep structures

14. The muscles of thorax Extrinsic muscles • Pectoralis major胸大肌 • Pectoralis minor 胸小肌 • Serratus anterior前锯肌 Intrinsic muscles • Intercostales externi肋间外肌 • Intercostales interni肋间内肌 • Intercostales intimi肋间最内肌

15. 4. Regional anatomy

16. Mamma 乳房 Position • Lie in superficial fascia over the pectorals major and pectoral fascia • Extend from 3rd to 7th ribs vertically, and from parasternal line to midaxillary line transversally

17. Structures －contains skin, mammary glands and adipose tissue • Each brest has about 15～20 lobes of mammary gland • Each lobe radiates out from the nipple and has a lactiferous duct 输乳管which opens separately on the summit of the nipple and possesses a dilated lactiferous sinuses 输乳管窦just prior to its termination

18. Suspensory ligaments of breast 乳房悬韧带(cooper’s ligaments ) －strands of connective tissue runs between skin and deep fascia and serve to support the mammary glands

20. Clavipectoral fascia 锁胸筋膜 • The deep faxcia which extends between subclavius, coracoid process and pectoralis minor muscles • The structures pass through the clavipectoral faxcia • Cephalic v. • Thoracoacromial a. • Lateral pectoral n.

21. 锁胸筋膜及其穿行结构 Clavipectoral fascia Suspensory ligament of axilla

22. Clavipectoral fascia 锁胸筋膜及其穿行结构 is pierced by the cephalic vein 头静脉, lymphatic vessels淋巴管,thoracoacromial artery and vein 胸肩峰动、静脉, lateral pectoral nerve胸外侧神经. “二进二出”

23. Ⅱ. The axillary region

24. Main contents Boundaries of the axilla Contents of the axilla Regional anatomy

25. Axillary fossa 腋窝一尖一底四个壁 1. Boundaries of the axilla • The axillary fossa is a pyramid-shaped space through which major neurovascular structures pass between the thorax and upper extremity

26. Boundaries of the axilla • The apex is a triangular space limited by the first rib, the scapula, and the middle third of clavicle. • The base－skin and fascia of the axillary fossa

27. The anterior wall • Pectoralis major, pectoralis minor and subclavius muscles • Clavipectoral fascia锁胸筋膜

28. The broad medial wall－serratus anterior，intercostal muscles and upper four ribs • The narrow lateral wall－coracobrachialis, biceps brachii and intertubercular groove

29. The posterior wall subscapularis 肩胛下肌, teres major 大圆肌 latissimus dorsi 背阔肌, scapula 肩胛骨

30. Boundaries of the axilla Apex Base：axillary fascia 腋筋膜 Anterior wall：pectoralis major and pectoralis minor 胸大、小肌 subclavius muscles 锁骨下肌 clavipectoral fascia 锁胸筋膜 Posterior wall：subscapularis肩胛下肌, teres major大圆肌 latissimus dorsi背阔肌, scapula 肩胛骨 Medial wall：serratus anterior 前锯肌， intercostal muscles 肋间内肌 and upper four ribs Lateral wall：coracobrachialis 喙肱肌, biceps brachii 肱二头肌 intertubercular groove 结节间沟

31. 2. Contents of the axilla Axillary artery Axillary vein Infraclavicular part of brachial plexus Axillary sheath Axillary lymph nodes

32. Axillary artery • Continuation of subclavian artery at lateral border of first rib • Becomes brachial artery at lower border of teres major • Divided into three parts by overlying pectoralis minor • thoracoacromial a. 胸肩峰动脉 • lateral thoracic a. 胸外侧动脉 • subscapular a. 肩胛下动脉, • throcodorsal a. 胸背动脉and circumflex scapular a. 旋肩胛动脉 • anterior and posterior humeral circumflex a. 旋肱前、后动脉;

33. Axillary artery were divided into three parts:

34. Axillary vein Axillary a. Thoracoacromial a. Lateral pectoral n. Musculocutaneous n. Medial antebrachial cutaneous n. Median n. Ulnar n. Medial brachial cutaneous n. Intercostobrachial n. Thoracodorsal n. & a. Long thoracic n. & lateral thoracic a.

35. Brachial plexus 臂丛 Formation: （根、干、股、束） • Five roots: formed by anterior rami of C5-C8 and T1 spinal nerves, roots C5～C7give rise to long thoracic n. 胸长神经 • Three trunks • Six divisions • Three cords: below clavicle, divisions form three cords that surround the second portion of axillary a.

36. Main branches • Lateral cord • Musculocutaneous n. 肌皮神经 • Lateral root to median n. 正中神经外侧根 • Medial cord • Medial root to median n. 正中神经内侧根 • Ulnar n. 尺神经 • Medial brachial cutaneous n. 臂内侧皮神经 • Medial antebrachial cutaneous n. 前臂内侧皮神经

37. Posterior cord • radial n. 桡神经 • axillary n. 腋神经 • thoracodorsal n. 胸背神经

38. Musculocutaneous肌皮神经

39. Median nerve正中神经 • Distribution • Injury: ape-like hand猿掌

40. Ulnar nerve尺神经 • Distribution • Injury: clawhand爪形手

41. Radialnerve 桡神经 • Distribution: • Injury: Wristdrop 垂腕

42. Axillarynerve • Distribution: • Injury: result in deltoid and teres minor paralysis

43. Axillary lymph nodes －arranged in five groups • Lateral lymph nodes 外侧淋巴结 • Pectoral lymph nodes 胸肌淋巴结 • Subscapular lymph node 肩胛下淋巴结 • Efferents above three groups pass to central lymph node 中央淋巴结

44. Central lymph node 中央淋巴结 • Apical lymph node 尖淋巴结

45. 3. Regional anatomy Trilateral and quadrilateral foramina 三边孔和四边孔 Axillary sheath 腋鞘 Lymph vessels and node of mammary gland

46. Trilateral and quadrilateral foramina 三边孔和四边孔 • posterior humeral circumflex a. and axillary n. pass through the quadrilateral foramen. • The circumflex scapular a. passes through the triangular space to reach the dorsum of the scapula.

47. Axillary sheath腋鞘 － extension of deep cervical fascia （颈深筋膜）of the neck, forming a tubular sheath that surrounds axillary a. and v., and brachial plexus

48. 乳房的淋巴引流

49. The superficial structures of anterior and medial regions of the thigh