Figure 9
Figure 10
Figure 11
Figure 6
Figure 7
Figure 8
13
12
Delto-pectoral Approach
The skin incision follows a line from the midpoint
of the clavicle to the midpoint of the arm (Figure 6).
subcutaneous flaps are elevated to expose the fatty strip
that demarcates the delto-pectoral interval (Figure 7).
Dissect medial to the cephalic vein and retract it laterally
with the deltoid muscle (Figure 8). incise the clavipectoral
fascia from the inferior border of the coracoacromial
ligament distally to the superior border of the tendon of
the sternal head of the pectoralis major (Figure 9). Dissect
the humeroscapular motion interface (subacromial,
subdeltoid and subcoracoid). palpate the axillary nerve at
the anterior-inferior border of the subscapularis muscle
(Figure 10). Electrocoagulate or ligate the anterior humeral
circumflex vessels (“three sisters”) near the humerus at
the inferior border of the subscapularis.
place a tag suture in the tendon of the subscapularis
(Figure 11), 2 cm medial to its point of insertion, in the
lesser tuberosity. Release the tendon, along with the
underlying capsule, from the lesser tuberosity and the
proximal humerus.
Ascertain the integrity of the biceps long head tendon. if
still present, tenodese it in the groove or to the pectoralis
major tendon, or proceed with a tenotomy for elderly
patients.
if necessary strip the remaining inferior and posterior-
inferior capsule from the humerus. Dislocate the humeral
head.
suRgicAL AppRoAch: DELTo-pEcToRAL
