Anterior approach to the humerus

Position

  • Supine
  • Arm board
  • Prep & drape arm free

Landmarks

  • Coracoid
  • Long head of biceps

Incision

  • Longitudinal incision along deltopectoral groove & lateral border of biceps
  • Start:
    • Coracoid process 

Internervous Plane

  • Proximally
    • Deltoid muscle
      • Axillary nerve
    • Pectoralis muscle
      • Medial and lateral pectoral nerves
  • Distally
    • Brachialis split
      • Musculocutaneous nerve (medially)
      • Radial nerve (laterally)

Superficial Dissection

  • Proximal
    • Develop the plane of deltopectoral groove & take cephalic vein laterally
    • Deltoid tuberosity & lateral lip of bicipital groove
  • Distal
    • Develop interval between biceps & brachialis
    • Retract biceps medially

Deep Dissection

  • Proximal
    • Incise periosteum lateral to insertion of pectoralis major
    • Continue proximally, staying lateral to biceps tendon
    • Ligate anterior circumflex humeral artery
    • If needed
      • Dissect subperiosteally
        • Insertion of pect major
        • Subscapularis
  • Distal
    • Split fibres of brachialis longitudinally
    • Strip brachialis off anterior surface of bone
    • Subperiosteal dissection

Dangers

  • Nerve
    • Radial
    • Axillary nerve
  • Vessels
    • Anterior humeral circumflex