Anterior Approach to Cubital Fossa

Indications

  • Reinsertion of biceps tendon
  • Release of anterior capsular contractions
  • Repair of nerves
  • Exploration of the pulseless pale paediatric supracondylar humeral fracture

Position

  • Supine
  • Armboard

Landmarks

  • Brachioradialis
  • Tendon of biceps
  • Anterior elbow crease

Incision

  • Curved longitudinal gentle S shaped incision over anterior aspect of elbow
  • Start: 5cm above elbow crease on medial side of biceps
  • Cross elbow crease oblique
  • End: continue on the medial border of brachioradialis

Internervous Plane

  • Proximally
    • Brachioradialis
      • Radial nerve
    • Brachialis
      • Musculocutaneous nerve
  • Distally
    • Brachioradialis
      • Radial nerve
    • Pronator teres
      • Median nerve

Superficial Dissection

  • Ligate numerous veins
  • Identify & preserve lateral cutaneous nerve of forearm
    • Between biceps & brachialis
  • Identify bicipital aponeurosis & incise it close to its origins at the biceps tendon
    • Being wary of brachial artery which runs deep to aponeurosis
  • Identify radial artery & trace it proximally to it’s origin in the brachial artery
    • Brachial vein & median Nerve run medial to artery

Deep Dissection

  • Develop plane between
    • Medially biceps & brachialis
    • Laterally BR
  • Supinate forearm
  • Incise origin of supinator

Dangers

  • Lateral cutaneous nerve of forearm
  • Radial artery
  • PIN