c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Axillary Lymph Node Dissection: 1

A D V E R T I S E M E N T

   
 

With the patient supine, a pad is placed behind the shoulder. The arm and shoulder are prepped circumferentially from mid-forearm to midline anteriorly and beyond the edge of latissimus posteriorly. The forearm is wrapped so that the arm can be manipulated and the arm is placed on a single armboard so that surgeon and first assistant can stand on either side of it. The second assistant stands on the opposite side of the table where the opposite arm is tucked. A transverse incision is made below the axillary hairline, extending a few centimeters over the edges of pectoralis and latissimus.     

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Axillary Lymph Node Dissection: 2

A D V E R T I S E M E N T

   
 

The incision is deepened to the investing fascia between pectoralis major and latissimus. The fascia is incised along the edge of the pectoralis muscle and the space between pectoralis major and minor is opened bluntly with finger dissection. The mobilization should be only enough to visualize the edge of the pectoralis minor and the clavipectoral fascia and not so high that the medial pectoral nerve is damaged (see axillary anatomy).      

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Axillary Lymph Node Dissection: 3

A D V E R T I S E M E N T

   
 

The arm is elevated to a vertical position and supported by the second assistant. This slackens the pectoralis muscles and allows the pectoralis major to be retracted for wide exposure. The clavipectoral fascia at the lateral edge of the pectoralis minor is sharply incised for the length of the muscle. The beginning of the axillary fat pad is a sharp, distinct plane beneath the fascia, clearly separate from the overlying subcutaneous fat.      

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This page was last modified on 6/20/1999.