Mammary gland, palm spaces, Arteries of the hand

This presentation describes Mammary gland, palm spaces, Arteries of the hand

Transcript

1. Mammary Gland Palm Spaces Arteries of the Hand With Arterial Arches
2. Mammary Gland (Breast)
3. Mammary Gland (Breast) Modified sweat gland that is responsible for milk formation. Age changes: Before puberty: Ducts only. After puberty: in female, glandular tissue and fats are formed. In males, ducts only. Size changes in females: 1st enlargement at puberty and 2nd enlargement at first pregnancy. Parts: Main part in superficial fascia of pectoral Region and tail in the axilla.
4. Tail of the breast Main part
5. External Features • Shape: It is hemispherical. It has base and apex. 1- Base: It is concave, separated from deep fascia of deep muscles by retro-mammary space. It extends upwards to 2nd rib, downwards to 6th rib, medially to margin of sternum and laterally to mid-axillary line. It is related to Pectoralis major, serratus anterior, external abdominal oblique muscles and rectus sheath. 2- Apex: Formed of nipple and areola. Nipple is conical that is present in the 4th intercostal space at mid-clavicular line. It contains terminations of 16 -20 lactiferous ducts. Areola is rounded pink (before pregnancy) or brown area around nipple and it is rich with sebaceous glands which become enlarged during pregnancy to form tubercles.
6. Mid-axillary line Sternum 6th rib 2nd rib Extensions of base of breast
7. Sub-mammary space Deep fascia (pectoral fascia) Pectoralis major m. Base of breast Dr. Sherif Fahmy
8. Nipple Areola
9. Structure of Breast 1- Parenchyma. 2- Stroma. 3- Skin.
10. Internal Structure •Breast is composed of 16 – 20 radially arranged lobes. •Lobes are separated from each other by fibrous septa (Suspensory ligaments of Cooper’s). •Each lobe contains fat as well as glandular tissue composed of lactiferous acini, ducts and sinuses.
11. Radial arrangement of glandular tissue
12. Lactiferous sinuses Glandular acini Fat lobules Lactiferous duct
13. Glandular acini Lactiferous sinuses Fat lobules Ducts
14. Blood Supply
15. A- Arterial Supply 1- Perforating branches of internal thoracic artery. 2- Lateral thoracic artery (from axillary artery). 3- Lateral cutaneous branches of posterior intercostal arteries. 4- Pectoral branch of acromio-thoracic artery.
16. Axillary artery Lateral thoracic artery Internal thoracic artery Perforating branches Mammary branches of posterior intercostal arteries
17. Pectoral branch from acromiothoracic artery Lateral thoracic astery Mammary branches from lateral cutaneous branches of posterior intercostal arteries Perforating branches of internal thoracic artery
18. Posterior intercostal artery Lateral cutaneous branch Mammary branches
19. Venous drainage Lateral thoracic vein to axillary vein Perforating veins to internal thoracic vein Mammary veins to posterior intercostal veins to azygos or heniazygos veins
20. Lymphatic Drainage Lymphatic plexuses: 1- Subareolar plexus: deep to areola and nipple drains superficial part of the breast. 2- Pectoral plexus: on pectoral fascia drains deep part of the breast. Both plexuses communicate together by interlobular lymphatics and sends efferent vessels to lymph nodes as follows:
22. Posterior (subscapular) nodes Pectoral nodes Apical nodes Parasternal nodes To posterior mediastinal nodes Subareolar plexus
23. Subcutanous lymphatics
24. Cancer Breast
26. Mammogram: X-ray picture on breast.
27. Palmar Spaces (Boundaries & Contents)
28. Palmar Compartments 1- lateral compartment (Thenar). 2- Medial compartment (Hypothenar). 3- Intermediate compartment: A- Mid-palmar space. B- Thenar space.
29. Lateral compartment Medial Compartment Adductor pollicis m. A line that divides middle compartment into mid-palmar (Medial) & thenar and adductor (Lateral)
30. Palmar (Hand) Spaces & their Contents
31. Lat. Med. Palmar aponeurosis Medial intermuscular septum Lateral intermuscular septum Intermediate intermuscular septum adductor pollicis muscle Thenar space Mid-palmar space
32. Contents of Palmar Spaces
33. Lat. Med. Superficial palmar arch & Branches of median and ulnar nerves Flexor digitorum tendons to medial 3 fingers & synovial sheath Adductor pollicis muscle Flexor digit tendons to index with blood & nerve supply to thumb and lateral side of index Deep palmar arch
34. Connections of the palmar Spaces Distally: With web spaces. Proximally: With carpal tunnel.
35. Distal Pulp Space
36. Bulb space
38. Arteries of the Hand
39. Orientation
40. Pisiform bone Hook of hamate Lower end of radius Base of 5th metacarpal bone 1st intermetacarpal space
41. Deep palmar arch Superficial palmar arch Ulnar artery Radial artery
42. Palmar aponeurosis Adductor pollicis m. Palmaris brevis m. Abductor pollicis brevis m. Abductor digiti minimi m. Flexor digiti minimi brevis m. Flexor pollicis brevis m.
43. Adductor pollicis 1st dorsal interosseous m.
44. Ulnar artery Flexor retinaculum Superficial palmar arch Radial artery Ulnar nerve Median nerve
45. Arterial Arches in the Hand 1- Anterior carpal arch: gives articular blood supply to wrist joint. 2- Superficial palmar arch: gives 3 common palmar digital arteries. 3- Posterior carpal arch: gives 2nd, 3rd and 4th dorsal metacarpal arteries. 4- Deep palmar arch: gives 3 palmar metacarpal arteries.
46. Arteries of the Hand 1- Ulnar artery. 2- Radial artery.
47. Ulnar Artery
48. Course of Ulnar Artery in the Hand
49. Ulnar artery Flexor retinaculum Deep br. of ulnar artery Thenar eminence Superficial palmar arch Superficial palmar branch from radial artery Pisiform bone Superficial branch of ulnar artery Hook of hamate Ulnar nerve
50. Surface Anatomy of Superficial Palmar Arch
51. Lateral to pisiform bone Medial to hook of hamate A curved line at level of distal margin of outstretched thumb
52. Relations of Superficial Palmar Arch Superficial: Skin, superficial fascia and palmar aponeurosis. Deep: Terminal branches of median nerve, flexor digitorum tendons, common synovial sheath and lumbricals.
53. Palmar aponeurosis
54. Superficial palmar arch Terminal branches of median nerve Tendons of flexor digitorum muscles & lumbricals Common synovial sheath
55. Branches of Superficial Palmar Arch 1- Palmar digital branch of little finger. 2- Three common palmar digital branches.
56. Palmar digital branch Three common palmar digital branches Two proper digital branches
57. Palmar metacarpal branch Communication between Branches of Deep Palmar Arch and branches of superficial palmar arch Deep palmar arch Common palmar digital branches
58. Radial Artery
59. Course of Radial Artery
60. Radial artery in the forearm Radial artery in anatomical snuff box Radial artery passes between 2 heads of 1st dorsal interosseous muscle Abductor pollicis longus tendon Extensor pollicis brevis tendon Extensor pollicis longus tendon
61. Radial artery 1st dorsal interosseous m
62. Transverse head of adductor pollicis m Oblique head of adductor pollicis Deep palmar arch Base of 5th metacarpal bone Deep branch of ulnar artery Radial artery in the palm Radial artery 1st dorsal interosseous m Deep branch of ulnar nerve
63. Surface Anatomy of Deep Palmar Arch
64. Curved line 1/2 inch proximal to superficial palmar arch A curved line at level of distal margin of outstretched thumb
65. Relations of Deep Palmar Arch Superficial: -Flexor digitorum tendons and lumbricals. Deep: Metacarpal bones (just distal to their bases) and interossei muscles. Concavity: Deep branch of ulnar nerve.
66. Branches of Radial Artery in the Hand Dorsum of hand: 1- Dorsal (posterior) carpal branch. 2- Dorsal digital branch. 3- First dorsal metacarpal branch. In the 1st intermetacarpal space: 1- Radialis indices. 2- Princips pollicis. In the palm (Deep palmar arch): 1- Three palmar metacarpal branches. 2- Proximal perforating arteries. 3- Recurrent branch to anterior carpal arch.
67. 2- Dorsal digital branch 3-1st dorsal metacarpal br. 1-Posterior carpal branch Radial artery Branches of Radial Artery on the Dorsum Dorsal (posterior) branch of ulnar artery Dorsal (posterior) carpal arch 2nd, 3rd and 4th dorsal metacarpal arteries
68. Perforating arteries: A- Proximal perforating arteries: Between dorsal metacarpal arteries and deep palmar arch. B- Distal perforating arteries: Between dorsal metacarpal arteries and palmar metacarpal arteries.
69. 2- Priceps pollicis artery 1- Radialis indices Branches of Radial Artery in the 1st Intermetacarpal Space (Between 1st dorsal interosseous and adductor pollicis muscles) Radial artery passing through proximal part of 1st intermetacarpal space
70. Palmar metacarpal branches Branches of Deep Palmar Arch Deep palmar arch Common palmar digital branches
71. Palmar metacarpal arteries Recurrent branch Anterior carpal arch
72. Arterial Arches in the Hand Superficial to flexor digitorum tendons. At the level of middle of shaft of metacarpal bones. Deep to flexor digitorum tendons. At level just distal to bases of metacarpal bones. Anterior to carpal bones, deep to flexor tendons. Posterior to carpal bones, deep to extensor tendons. -Mainly superficial branch of ulnar artery. -Superficial palmar branch of radial a. -Mainly radial artery. -Deep branch of ulnar artery. -Anterior carpal branches of radial& ulnar arteries. -Descending branch of anterior interosseous artery. -Recurrent branch from deep palmar arch. It is a cruciate anastomosis. -Posterior carpal branches of radial& ulnar arteries. -Anterior & posterior interosseous artery. -3 common palmar digital arteries. -Palmar digital artery. -3 palmar metacarpal arteries. -Proximal perforating arteries. -Recurrent branch. -Articular branches to wrist joint. -2nd, 3rd and 4th dorsal metacarpal arteries. Site Formation Branches Superficial palmar Deep palmar Anterior carpal Posterior carpal Dr. Sherif Fahmy