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Saint Louis University

medi Anatomy
sina
2019

Dr. Ngalob 10/15/15 | Axillary Region: Landmarks,


Boundaries, Proximal Upper Limb: Circulation

Transcribers: Olangcay, Orcilla, Padiernos


AXILLA

Part of the shoulder together with the pectoral


(anteriorly), the deltoid and the scapular regions
(posteriorly)
An anatomic pyramid situated between the:
o Medial side of the upper arm, and the
o Lateral side of the chest wall
Since it is pyramidal in shape, it consists of 4
walls, an apex, and a base
Medial wall lateral part of the chest
wall, lateral of it is the medial part / inner
part of the upper arm
Posterior wall scapula
Apex pointed towards the clavicle
base pointed towards the latissimus
dorsi

consists of the 2nd-6th ribs and serratus


anterior

4. Lateral humeral wall (medial side of the


upper arm)
formed by the humerus

Apex

blunted and is bounded by 3 bones:


a. Clavicle anteriorly primary boundary of
the apex of the axilla
b. Upper border of scapula posteriorly
c. 1st rib medially

Base

Made up of the skin, subcutaneous tissue and


axillary fascia, and latissimus dorsi

Components of the subcutaneous tissue:


Axillary Vessels:
a. Axillary Nerve
b. Axillary Artery
c. Axillary Vein
Walls:

Superficial superficial fatty layer aka


Campers layer
Deep membranous aka Scarpas Fascia
occasionally, a small strip of muscle is
found in this area, and forms an
anomalous axillary arch

1. Anterior pectoral wall consists of:


a. Superficial pectoralis major (beneath the
skin) and its fascia
b. Deeper pectoralis minor and subclavius and
its fascia
2. Posterior scapular wall
Formed by the scapula, subscapularis,
latissimus dorsi and teres major
3. Medial costal wall

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ANATOM
Dr. Laygo |

Axillary Region: Landmarks, Boundaries, Proximal Upper Limb: Circulation

Axillary Vein

1st structure to appear after incision is made


into the axillary sheath
Unlike any other vein, axillary vein cannot
be ligated
Formed by the junction of the 3 veins of the
superior extremity:
o 2 brachial veins
o 1 basilic vein
Begins at the lower border of teres major,
then it continues to the outer border of the
1st rib, where it becomes the subclavian
vein
Subclavian vein then joins with the internal
jugular vein to form the inominate vein

Axillary Artery

Other veins that should not be ligated:


a.
b.
c.
d.

carotid
vena cava
femorals
iliacs
*if damaged, the vein should be repaired

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Continuation of the subclavian artery and is


about 6 inches in length
Starts at the outer border of the 1st rib and
ends at the lower border of the teres major,
where it becomes the brachial artery
Before it crosses the teres, it is the
brachiocephalic
The pectoralis minor divides the axillary
artery into 3 parts:
o 1st part: proximal to the pectoralis
minor
Has one branch: superior
thoracic artery

ANATOM
Axillary Region: Landmarks, Boundaries, Proximal Upper Limb: Circulation

Dr. Laygo |

2nd part: behind the pectoralis minor


(shortest segment)
Has 2 branches: thoracoacromial and lateral
thoracic arteries
3rd part: distal to pectoralis minor
Has 3 branches:
subscapular, anterior
humeral circumflex, and
posterior humeral
circumflex arteries

Gives rise to the circumflex


scapular artery, anterior and
posterior humeral
o Supplies the entire posterior axillary
wall
o Branches of this artery accompany
the 2 major nerves of the breast:
Thoracodorsal nerve
(innervates latissimus
dorsi)
* if transected unable to
push/weak push
Long thoracic nerve of
bell (innervates serratus
anterior)
*if transected winging of
scapula
o

Anterior and posterior circumflex


arteries
o Form an arterial ring around the
surgical neck of the humerus

Circulation of the Upper Arm

Arterial Supply of the Axilla

Superior Thoracic Artery


o 1st branch of the axillary artery and
the only branch of 1st part
o Supplies the muscles of the 1st 2
intercostal spaces
Thoraco-acromial artery
o Arises from 2nd part
o Has 4 branches: pectoral,
acromial, deltoid, and clavicular
(PAD-C)
Subscapular artery
o Largest branch of the axillary artery
o Supplies the posterior axillary wall

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Brachial artery
o Direct continuation of the axillary
artery
o Starts at the lower border of the
teres major and terminates 1 inch
below the transverse skin crease
of the elbow
o Divides into a larger ulnar artery
and a smaller radial artery
*If ever both the brachial artery and
ulnar artery are transected, first to save is
the ulnar

The brachial artery lies successively on 3 muscles,


gives 3 main branches, has 3 important nerves,
and is associated with 3 veins

ANATOM
Dr. Laygo |

Axillary Region: Landmarks, Boundaries, Proximal Upper Limb: Circulation

3 main branches:
a. Profunda brachii accomplishes the
radial nerve
b. Superior collateral ulnar artery
accompanies ulnar nerve
c. Inferior ulnar collateral artery a.k.a
anostomotica magna
3 important nerves:
a. Radial and (b) ulnar nerves- associated
with the brachial artery only on the
proximal part
c. Median nerve- associated with the
brachial artery throughout its entire
course
3 veins:
2 brachial veins, 1 basilic

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