• Use a fresh scalpel blade each time you begin a new area.  If you are uncertain how to change a blade, ask an instructor.  Always dispense of blades in the designated receptacles.
• Note the body fat content of the cadaver to determine a relative depth of all incisions.  Excessively deep incisions run the risk of damaging structures in a particular area.
• Lymph tisue in the axilla should be removed only after understanding of the drainage pattern is fully understood. Lymph nodes appear as pea-sized, dark, solid structures.
• All nerves innervate muscles from their deep surface with the exception of serratus anterior.
• Keep area moist with preservative to prevent tissue dessication.

 

    1.  Make an incision made from the midline of the sternum extending from the xiphoid process to the jugular notch.  Extend the incision laterally from the xiphoid process and laterally from the jugular notch, along the clavicle to the acromion process of the scapula.  This will create a flap of skin which will open the anterior chest wall.
    2.  Remove the underlying fat and fascia from the chest wall exposing pectoralis major.
    3.  Detach pectoralis major by making an incision along its sternocostal origin about a quarter of an inch lateral to the sternum.  Free the muscle from underneath using your hand; be gentle avoiding damage to the sturctures that lie deep to the muscle.  Reflect the muscle laterally towards its insertion on the humerus.  Preserve the nerves beneath the muscle and distinguish between the lateral and medial pectoral nerves.
    5.  Trace the nerves of the pectoral region to the axillary region and clean them of any fat and fascia.
    6.  Extend the incision from the acromion process down the anterior midline of the arm.  Clean and expose the axillary region of any fat and/or fascia.
    7.  Identify the brachial plexus and the axillary artery and vein; these will have to be dissected form the axillary region.
    8.  Identify the medial triangular space and understand the borders of the space.  Note that the circumflex scapular artery passes through the space.
    9.  Identify the nerves and vessels that pass along the outside of the thoracic wall.