Piermattei's Approaches - Thoracic Limb Flashcards
Approach to the proximal humerus
Approach
- Skin incision just lateral to the midline of the humerus from the greater tubercle to the midshaft
- Incise throug the deep fascia along the lateral border of the brachiocephalicus muscle and through the insertion of the acromial part of the deltoideus
- Ligate the omobrachial v at the mid brachiocephalicus m
- Retract brachiocephalicus cranially after blunt dissection off the bone
- Retract the deltoideus caudally
- If necessary, lateral head of the triceps (caudolateral) and the superficial pectoral (craniomedial) can be incised
Closure
- fascia of the superficial pectoral and deltoideus together
- fascia and the caudal brachiocephalicus m
Approach to the midshaft of the humerus through a craniolateral incision
Approach
- Skin incision from greater tubercle to the lateral epicondyle along the craniolateral border
- Brachial fascia is incised along the caudal border of the brachiocephalicus
- Ligate the cephalic vein proximally and distally
- Ligate the omobrahical and axillobrachial vv are ligated
- Incise the craniomedial fascia of the brachialis m and the insertion of the triceps on the bone
- WATCH THE RADIAL NERVE OVER THE BRACHIALIS M
- Elevate the superficial pecoral and brachiocephalicus m from the humeral shaft
Closure
- Close the superficial pectoral and brachiocephalicus to the brachialise muscle distally and the deltoideus proximally
- Triceps is closed to the brachiocephalicus
- Brachial fascia
Approach to the distal shaft of the humerus through a craniolateral incision
Approach
- Incise skin from the midshaft to the lateral epicondyle
- Avoid or ligate the cephalic and axillobrachial vv
- Incise the fascia along the cranal border of the triceps m
- PROTECT THE RADIAL N AT THE DISTAL INCISION
- Cranial retraction of the brachiocephalicus m and the cephalic v
- Incise the periosteal insertion of the superficial pectoral m
- Brachialis m can be elevated from the bone and retracted caudally WITH THE RADIAL N (or cranially for more distal exposure)
Closure
- Brachialis to the brachiocephalicus/superficial pectoral
- Fascia to the triceps
Approach to the distal shaft and supracondylar region of the humerus through a medial incision
Approach
- Incise from the midshaft to the medial epicondyle along the cranial border
- Identify the brachial and collateral ulnar vessels
- Incise the fascia between the vessels
- Begin subfascial dissection at the medial epicondyle and continue procimally until the median and ulnar nerves are identified
- Mobilize the nerves and vessels as necessary
- Biceps brachii and triceps mm are elevated from the bone
- Elevate the brachiocehpalicus and superficial pectoral if necessary for cranial exposure
- in the cat, the brachial a and median n pass through the supracondylar foramen; they also have a short part of the medial head of the triceps and the ulnar n lies beneath it
Approach to the lateral aspect of the humeral condyle and epicondyle in the dog
Approach
- Incise the skin from the distal 25% of the humerus, across the joint and to the ulna, just caudal to the lateral epicondyle
- Incise the deep fascia along the cranial border of the triceps and continued distally over the extensors
- Retraction of the fascia of the humerus exposes the distal bone, NOTE THE RADIAL N
- Incise between the ECR and the CDE mm and elevate the ECR from the lateral humerus
- Open the joint capsule with an L shaped incision
Closure
- Close the joint capsule
- Close the intermuscular incision
Approach to the lateral humeroulnar part of the elbow joint
Approach
- Skin incision over the lateral humeral epicondyle and curves to follow the epicondylar crest
- Incise the fascia of the brachium along the cranial border of the triceps
- Elevate the triceps to expose the anconeus m
- Incise the anconeus m at its humerus origin
Closure
- Close the anconeus m to the origin of the extensors
Approach to the olecranon
Approach
- Incision between the lateral humeral epicondyle and the olecranon, curving to follow the humeral condyle
- Incise the brachial fascia cranial to the triceps
- Periosteal incision on the olecranon at the insertion of the anconeus
Approach to the distal shaft of the ulna
Approach
- Incise skin directly over the lateral surface of the bone
- Incise the fascia between the ulnaris lateralis caudally and the lateral digital extensor cranially
- The APL can be elevated from its origin
Approach to the shaft of the radius through a medial incision
Approach
- Incise the skin from the medial epicondyle to the styloid process
- Avoid the cephelic v distally
- Incise fascia between the ECR and the pronator proximally
- Retract the extensors cranially and elevate the pronator and supinator mm if necessary from the bone
Approach to the head and proximal metaphysis of the radius
Approach
- Incise the skin from the lateral epicondyle of the humerus following the craniolateral border of the radius
- Incise the antebrachial fascia on the same line
- Incise between the ECR and the CDE JUST DISTAL TO THE SUPERFICIAL BRANCH OF THE RADIAL N
- IDENTIFY THE DEEP RADIAL N BRANCH BENEATH THE SUPINATOR M
- Elevate the supinator starting distally and protect the radial n proximally
Approach to the shaft of the radius through a lateral incision
Approach
- Centered over the lateral edge of the radius
- Incise the fascia along the cranial border of the CDE, over the bone, and caudal to the ECR
- Rectraction of the extensors and the ECR allow good exposure
- Can incise the APL
Approach to the distal radius and carpus through a dorsal incision
Approach
- Incise the skin from the cephalic v branch to the mid-metacarpals, following the lateral aspect of the accessory cephalic v
- Incise the fascia between the ECR and the CDE
- Incise into joint spaces as necessary
- Elevate the APL if necessary
Approaches to the MCP bones
Approach
- Incise directly over the affected bone, or between 2 bones if necessary to access 2
- To access all, make a curved incision starting at proximal MCP 2, heading laterally to MCP 5 and then medially to end at distal MCP 2
