Not extensile
Position
- supine
- Mayfield headrest
- Beach chair 45°
- sandbag
Landmarks
- acromion
- clavicle
- spine of scapula
Incision
- 5cm longitudinal incision
- Start: tip of acromion
- End: down lateral aspect of arm
Internervous Plane
- none
Superficial Dissection
- fat
- deep fascia
- split deltoid in line with fibres
- stay suture at inferior aspect to avoid damage to axillary nerve
Deep Dissection
- lateral aspect of upper humerus, R/C & SA bursa will be exposed
Dangers
- axillary nerve
- leaves posterior wall of axilla by penetrating quadrangular space
- winds around humerus with posterior circumflex humeral arteries
- enters deltoid posterior from its deep surface 7 cm below tip of acromion
- nerve fibres then spread anteriorly