What are the borders of the axilla?
apex - cervicoaxillary canal
anteriorly - pectoralis major and minor
posteriorly - subscapularis / teres major / latissimus dorsi
laterally - bicipital groove of humerus
medially - serratus anterior
base - axillary fascia
What are the borders of the cervicoaxillary canal?
anteriorly - clavicleThis aperture extends into the posterior triangle of the neck
posteriorly - scapula
medially - 1st rib
What is the pectoral fascia?
A superficial layer investing the pectoralis major
What is the clavipectoral fascia?
A deep layer extending from the clavicle to the axillary fascia, investing the subclavius and pectoralis minor muscles
What is the costocorocoid membrane?
The superior portion of the clavipectoral fascia, above the pectoralis minor
What pierces the costocorocoid membrane?
1. cephalic vein
2. lateral pectoral nerve
3. thoracoacromial artery
What is the coracoaxillary membrane?
The inferior portion of the clavipectoral fascia, below the pectoralis minor
AKA suspensory ligament of axilla
What is the Halsted Ligament?
Dense condensation of clavipectoral fascia between the medial portion of the clavicle and the 1st ribInvests the subclavian artery and vein as they traverse the 1st rib
What comprises the anterior axillary fold?
The lateral border of the pectoralis major
What comprises the posterior axillary fold?
Teres major and latissimus dorsi
What does the lateral pectoral nerve supply?
Pectoralis majorThis is derived from the lateral cord (C5-7) of the brachial plexus and pierces the costocorocoid membrane.
What does the medial pectoral nerve supply?
Pectoralis major and minorThis is derived from the medial cord (C8, T1) of the brachial plexus and runs on the deep surface of the pectoralis minor, then pierces it to innervate both muscles.
What are the contents of the axillary sheath?
Axillary artery, 1st portion
Axillary vein
Brachial plexus
What are the borders of the 1st portion of the axillary artery?
medially - 1st rib
lateral/inferiorly - pectoralis minor
What are its branches?
Only one: the superior thoracic arterySupplies the upper serratus anterior and intercostal spaces
What borders the 2nd portion of the axillary artery?
anteriorly - pectoralis minor
medially - medial cord of brachial plexus, axillary vein
laterally - lateral cord of brachial plexus
posteriorly - posterior cord of brachial plexus
What are its branches?
1. Thoracoacromial artery
2. Lateral thoracic artery
Both supply the pectorals. The thoracoacromial artery pierces the clavipectoral fascia and divides into acromial, deltoid, pectoral, and clavicular branches. The lateral thoracic also supplies axillary lymph nodes and the lateral breast.
What are the borders of the 3rd portion of the axillary artery?
medial/superiorly - pectoralis minor
lateral/inferiorly - teres major
What are its branches?
1. Subscapular arteryThe subscapular artery divides into the circumflex scapular artery (supplies dorsum of scapula) and the thoracodorsal artery (supplies latissimus dorsi).
2. Anterior circumflex humeral artery
3. Posterior circumflex humeral artery
The anterior CHA passes deep to the biceps brachii and coracobrachialis while winding around the neck of the humerus. The posterior CHA passes through the quadralangular space of the posterior wall of the axilla along with the axillary nerve to supply the deltoid and triceps brachii. Both anastomose...
What would happen with ligation of the axillary artery proximal to the subscapular artery?
Likely nothing due to extensive scapular collateralization between the thyrocervical trunk (3rd branch of subclavian) and the subscapular artery
What would happen with ligation of the axillary artery distal to the subscapular artery?
Distal ischemia
What vessel becomes the axillary vein as it crosses the teres major?
basilic vein
What lies in the deltopectoral groove?
cephalic vein
Where does the cephalic vein drain into the axillary vein?
superior to the pectoralis minor
What does the long thoracic nerve supply?
serratus anterior
The long thoracic n is derived from roots C5-7, enters into the axilla via the cervicoaxillary canal, and lies superficial to the serratus anterior, invested in its fascia. Injury will result in "winged scapula", leading to an inability to abduct the arm above horizontal.
What does the thoracodorsal nerve supply?
latissimus dorsi
The thoracodorsal n is derived from the posterior cord of the brachial plexus and lies medial to the latissimus dorsi. Preservation is imperative for functional latissimus myocutaneous flap reconstructions.
What does the intercostobrachial nerve supply?
sensation to the skin of the apex and lateral axilla and the upper medial and inner aspect of the arm
We'll talk about axillary lymph nodes later... SG
Sources:
Moore's Clinically Oriented Anatomy, 3rd ed.
Mastery of Surgery, 5th ed.
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