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Position
- supine
- Mayfield headrest
- Sandbag under spine & medial border of scapula
- Beachchair 45°
- Prep & drape limb free
Landmarks
- Clavicle
- Acromion
- Spine of scapular
- Coracoid process
Incision
- Transverse incision
- Start: anterolateral corner of acormion
- End: just lateral of coracoid process
Internervous Plane
- None
- Deltoid muscle is detached proximal to nerve supply
Superficial Dissection
- Subcutaneous fat
- Ligate numerous vessels
- Deep fascia
- Palpate AC joint
- Detach fibres of deltoid from AC joint & continue laterally to expose 1cm of anterior aspect of acromion
- Ligate acromial branch of coracoacromial artery
- Split deltoid in line of its fibres starting at AC joint
- Extend 5cm
- Insert stay sutures at apex of split to avoid damage to axillary nerve
Deep Dissection
- Detach coracoacromial ligament from acromion
- You can now see supraspinatus & SA bursa
- Rotate humeral head to expose different parts of R/C & long head of biceps
Dangers
- Axillary nerve
- Runs transversely deep to deltoid 7cm below tip o
