Topographical and surface anatomy of the thorax, clinical relevance

Regional lymphnodes with special

reference to the mamma

Dr. Judit Tamás Semmelweis University Faculty of Medicine

I. Department of Surgery

BONY FRAMEWORK OF THE THORAX

THORACIC CAVITY - superior thoracic aperture (Th2) Borders: Th1, 1st ribs, sternum, pleura „open” - inferior thoracic aperture (Th10) Borders: Th12, 11-12th ribs, costal arch, xiphoid process diaphragm

costal arch

CONTENTS – palpation, percussion, auscultation

CONTENTS – palpation, percussion, auscultation

CONTENTS – chest X-ray

Lung operations incisions

STERNOTOMY

LANDMARKS ON THE VENTRAL SURFACE OF THE THORAX

Jugular

Th2

2nd rib/ Th4-5

4th IC space / Th8

Subcostal plane – L3

TOPOGRAPHICALLY RELEVANT PLANES OF THE THORAX

MUSCLES

NEXT SLIDE

DUAL-PLANE AUGMENTATION

MUSCLES

... from back

DORSO-LATERAL THORACOTOMY

VERTEBRAE

EPIDURAL/SPINAL ANAESTHESIA

BLOOD SUPPLY

VEINS

INTERCOSTAL SPACE – vessels & nerves

THORAX PUNCTION intercostal block

THORAX PUNCTION

+/- DRAINAGE

TENSION PTX

HEART DISPLACINT INTO THE RIGHT

ASYMMETRIC CHEST EXPANSION

TENSION PTX punction site

SUBCLAVIAN VEIN PUNCTURE

THORACIC OUTLET SYNDROME

• Brachial plexus

• Subclavian artery

• Positional

• Static • Pancoast tumor

• Cervical rib

• Muscle enlargement

• 1st rib fixation

INNERVATION

Dermatomes Cutivisceral reflexes

Burning or silent nipple after augmentation

Innervation of the nipple anterior and lateral cutaneous branches of the third through fifth intercostal nerves the fourth lateral cutaneous branch

PECTUS CARINATUM

PECTUS EXCAVATUM

DIAPHRAGM - oesophagus

LYMPHATIC DRAINAGE

FOSSA AXILLARIS

LYMPHATIC DRAINAGE OF BREAST

Sappey – subareolar plexus 75% - axilla 15% - internal mammar Upper – supraclavicular Lower- infradiaphragmatic

SENTINEL LYMPH NODE BIOPSY – 99m Tc

BREAST CANCER – RECONSTRUCTIVE SURGERY

• GENERAL SURGEON

• PLASTIC SURGEON

• „BREAST SURGEON”

• Double attack : against life + against feminity (John Bostwick)

Halsted Radical mastectomy

Patey Modyfied radical mastectomy

Veronesi Breast conserving surgery

Oncoplasty

VASCULAR SUPPLY OF BREAST

- internal mammary artery branches

- lateral thoracic artery

- thoracodorsal artery

- intercostal perforators

- thoracoacromial artery

VEINS

SUBAREOLAR VENOUS PLEXUS

BREAST CONSERVING

SECTOR EXCISION

DERMOGLANDULAR ROTATION

BREAST RECONSTRUCTION

Autologous reconstruction is the best

Autologous reconstruction is the best

LATISSIMUS DORSI MYOCUTAN FLAP

TRAM

Transverse rectus abdominis muscle

Nipple sparing subcutan mastectomy primer augmentation + TiO2 mesh

Free flaps – microsurgery – microanastomosis

MASTOPEXY

Mastopexy / Reduction

Orientation of the pedicle: - maximize vascularity and sensation to the nipple - optimizing aesthetic out-come

Formation of pedicle: - wide as possible to maximize vascularity - narrow enough for sufficient reduction

MALE BREAST • No lobules or alveoli

• BUT CANCER!!!!

GINECOMASTY

THANK YOU FOR YOUR ATTENTION