MASTECTOMY, STEP 5 SURGERY .

MASTECTOMY, STEP 5 SURGERY

• Step 5: Cleaning out the armpit. Expose the armpit vein. The armpit vein usually is a large single trunk but often is found as two branches.








The nerves of the brachial plexus surround the armpit vein. A number of tributary veins enter it from the armpit fat; the largest and most important of these is the scapular vein which accompanies the scapular artery; Fig. 14.











Fig. 14:



A Both pectoral muscles are strongly retracted inferiorly. The fascia overlying the axillary vein is removed, care being taken not to injure this vessel. The axillary fat is exposed:



1, Deltoid muslle; 2, cut edge of pectoral minor tendon; 3, axillary vein; 4, cut edge of pectoral major tendon; 5, pectoral major muscle; 6, pectoral minor muscle; 7, axillary fat pad; 8, coracobrachialis muscle; 9, cut edge of pectoral major muscle; 10, short head of biceps muscle.







B The axilla is cleaned by blunt dissection. Note the cords of brachial plexus and the axillary artery:



1, Cords of brachial plexus; 2, cephalic vein; 3, axillary vein; 4, axillary artery; 5, short thoracic vessels; 6, serratus anterior muscle; 7, long thoracic nerve; 8, pectoral minor muscle; 9, pectoral major muscle; 10, axillary fat pad with lymphatics; 11, thoracodorsal nerve, 12, latissimus dorsi muscle.