The Upper Limb1上上肢肢的的境境界界与与分分区区2Boundary and Region上上肢肢的的境境界界与与分分区区3Boundary and RegionBoundary and Region4Boundary and Region5Surface anatomy6Surface anatomy7Skin incisionsPlease refer to the red dashed lines & the green solid lines when making incisions.Make sure the skin be reflected to the point of posterior axillary line.8The Pectoral Region 胸前区胸前区9Cutaneous nerves and vessels10The breast11Key StructuresCoopers ligamentsMammary glandLactiferous ductRetromammary spaceMamma12Suspensory ligaments of breast乳房悬韧带乳房悬韧带Retromammary spaceMammary glandLactiferous duct乳房后间隙乳房后间隙1415Lymphatic Drainage of The Breast乳房淋巴回流乳房淋巴回流 Lymphatic Drainage of The Breast乳房淋巴回流乳房淋巴回流 Breast CarcinomaProfound structureClavipectoral fascia 锁胸筋膜锁胸筋膜The structures pass through the clavipectoral fasciaCephalic v.头静脉Thoracoacromial a.胸肩峰动脉Lateral pectoral n. 胸外侧神经 The Pectoral Region 胸前区胸前区24Clavipectoral fasciaPectoralis major 胸大肌 Subclevius 锁骨下肌Pectoralis minor 胸小肌 Serratus anterior 前锯肌Axilla27 The Axillary fossa 腋窝腋窝Boundaries The Axillary fossa 腋窝腋窝The anterior wall The posterior wallTrilateral and quadrilateral foramina Posterior humeral circumflex a. & axillary n.腋神经和旋肱后血管腋神经和旋肱后血管 Circumflex scapular a.旋肩胛血管旋肩胛血管 The medial wallThe lateral wallAxillary sheath 腋鞘腋鞘 Axilla Contents36Brachial plexus 臂丛臂丛Formation:Long thoracic n. 胸长神经胸长神经Main branchesBranches of infraclavicular partPosterior cord axillary n. radial n.thoracodorsal n. subscapular n. first ribteres majorpectoralis minorAxillary artery 腋动脉腋动脉Branches:Subscapular a. 肩胛下动脉肩胛下动脉Throcodorsal a. 胸背动脉胸背动脉 Circumflex scapular a. 旋肩旋肩胛动脉胛动脉Axillary lymph nodes 腋淋巴结腋淋巴结 Central lymph node 中央淋巴结中央淋巴结Apical lymph node 尖淋巴结尖淋巴结 Superficial structuresAnterior Region of Arm 臂前区臂前区Basilic vein 贵要静脉贵要静脉Median cubital vein 肘正中肘正中静脉静脉 Superficial structuresThe anterior osseofascial compartment of the arm 前骨筋膜鞘前骨筋膜鞘 48Brachial artery 肱动脉肱动脉 Deep structures49Radial n.桡神经桡神经 Musculocutaneous n.肌皮神经肌皮神经Median n.正中神经正中神经Medial brachial cutaneous n.臂内臂内侧皮神经侧皮神经 Ulnar n.尺神经尺神经Medial antebrachial cutaneous n.前臂内侧前臂内侧皮神经皮神经 Superficial structuresAnterior Region of elbow 肘前区肘前区Cubiral fossa 肘窝肘窝Boundaries ContentsMedial to biceps brachii tendonLateral to the biceps brachii tendonThe anterior osseofascial sheath 前骨前骨筋膜鞘筋膜鞘 Anterior Region of Forearm前前臂前区臂前区 55Superficial layerBrachioradialis 肱桡肌肱桡肌Pronator teres 旋前圆肌旋前圆肌Flexor carpi radialis 桡侧腕屈肌桡侧腕屈肌Palmaris longus 掌长肌掌长肌Flexor carpi ulnaris 尺侧腕屈肌尺侧腕屈肌Muscles56Second layer Third layerFourth layerAction:57Palmar carpal ligament 腕掌侧韧带腕掌侧韧带Flexor retinaculum 屈肌支持带屈肌支持带Ulnar carpal canal 腕尺侧管腕尺侧管Radial carpal canal 腕桡侧管腕桡侧管Carpal tunnel 腕管腕管 Composition: Structures passing through the carpal tunnel Hand Palm 手掌手掌61Ten Layers of the palm62From superficial to deep: 1.Skin 皮肤皮肤 2. The superficial fascia 浅筋膜浅筋膜 3. Deep palmar aponeurosis 掌部深筋膜web space指蹼间隙 Osseofascial compartments of palm 手掌骨筋膜鞘手掌骨筋膜鞘Lateral compartment 外侧鞘外侧鞘Medial compartment 内侧鞘内侧鞘Intermediate compartment 中间鞘中间鞘Medial intermuscular septum掌内侧肌间隔掌内侧肌间隔 Intermediate compartment 中间鞘中间鞘664. Superficial palmar arch 掌浅弓 5. The terminal branches of the median nerve and the superficial branch of the ulnar nerve 正中神正中神经分支及尺神经浅支经分支及尺神经浅支 68recurrent n.返支返支 common palmar digital n.指掌侧总神经指掌侧总神经 6. The flexor tendons and synovial sheaths and the lumbrical muscles 屈指肌屈指肌腱及其屈肌总腱腱及其屈肌总腱鞘和蚓状肌鞘和蚓状肌 7. Fascia spaces 筋膜间隙筋膜间隙8. Palmar interosseous facia 骨间掌侧筋膜骨间掌侧筋膜 9.Deep palmar arch掌深弓 10. The interossei muscles and metacarpal bone 骨间肌和掌骨74手手部部皮皮肤肤切切口口Skin incisionsPlease refer to the right image when making incisions on hand.手掌：十层结构：手掌：十层结构：From superficial to deep: 1. Skin 2. Superficial fascia 3. Palmar aponeurosis 4. Superficial palmar arch 5. Median N. 6. Flexor tendons & their sheaths and lumbrical M. 7. Spaces 8. Palmar interosseous fascia 9. Deep palmar arch 10.interossei M. & metacarpalPosterior region of upper limbLayerScapular regionSuperior Lumbar Triangle 腰上三角腰上三角 Inferior Lumbar Triangle 腰下三角腰下三角 Deltoid & scapular regionsSuperficial Structures -Deltoid & scapular regions2. Deep StructuresDeltoid 三角肌三角肌Supraspinatus 冈上肌冈上肌Infraspinatus 冈下肌冈下肌Teres minor 小圆肌小圆肌Teres major 大圆肌大圆肌Subscapularis 肩胛下肌肩胛下肌2. Deep Structures(1) Scapular Region (3) Back of ForearmSkin incisionsPlease refer to the right figure when making incisions on back region.