Thorax

• epidermis
• dermis

• elastic
• collagen
• reticular

• thick: palm and sole
• thin: eyelids, abdomen

• hair
• nails
• sweat glands
• sebaceous glands
• ceruminous glands
• mammary glands

• protection
• reception
• excretion/absorption
• regulation of body temp

• secretion
• hair
• pigment
• thickening

• tactile
• pain
• pressure
• thermal

• evaporation of sweat
• cooling of blood

• flexure lines
• tension lines
• friction lines
• age changes
• dermatomes

• over joints
• skin moves freely over superficial fascia
• may be wrinkled or folded (not palm or soles)

• AKA langer's lines
• skin not smooth
• geometric pattern of creases
• follow bundle of collagen

• AKA ridges
• palm and sole
• alternate ridge and groove
• give finger and footprints

periosteum attached to skin

• translucence or thinning
• wrinkles caused by loss of fat
• loss of hair
• appearance of liver spots on face and hands

nerve supply: area of skin supplied by sensory fiber ot a dorsal root from dorsal and ventral rami of the spinal nerves

adjacent dermatomes overlap: Cn1-8 Tn1-12 Ln1-5 Sn1-5 Con-1

need 3 contiguous spinal nerves to be anesthesized during surgical procedures

help detect neurological lesions

• T4 nipple
• T10 navel
• T12 above pubic bone
• L4 hallux (big toe)
• C7 middle finger
• C8 little finger

mix of fat and c.t.

• superficial: more fat than fiber
• deep: more fiber than fat

• pattern: regular or irregular (random)
• surrounds muscle

breast and axillary tail make up mammary gland

• between sternum and mix-axillary line
• between ribs 2-6

• intercostal space 4
• on top of pectoralis major and minor

• modified sweat gland
• made of fat and glands
• can be divided into 4 quadrants

• non lactating: more fat than gland
• lactating: more gland than fat

60% can be found in superolateral quadrant

fat, gland, lactiferous duct and sinus, ligament of cooper, areola

• pectoral branch of thoracoacromial artery
• lateral thoracic artery
• posterior intercostal arteries
• anterior perforating branches of internal thoracic (mammary artery)

• axillary nodes: 75% of drainage. 1=apical 2=central 3=anterior 4=lateral 5=posterior
• transpectoral
• parasternal (internal thoracic artery)
• opposite breast
• ligamentum teres (to liver)

spreads to lungs, mediastinum, and liver

• 1) Radical mastectomy: remove breast, axillary lymph nodes, major and minor pectoralis parts, medial and lateral nerves, medial, lateral, and minor arteries, opposite breast
• 2) lumpectomy
• 3) mammogram

• sternum
• thoracic inlet
• structures in thoracic inlet

• manubrium sterni
• body
• xyphoid process

• 1st rib
• manubrium sterni
• 1st thoracic vertebra

• trachea
• espohagus
• vagus and phrenic nerves
• apex of lung

• T12
• Rib 12
• costal margin

• xiphoid process at level of Tv10 or Tv11
• manubrio-sternal joint, sternal angle (angle of louis) at lower border ot Tv4: costal cartilage of rib 2 articulates directly in this joint

• 12 pairs = 24 total
• rib 7=longest
• rib 12= shortest
• rib 1= sometimes called shortest

• features
• a: typical ribs=3-9 have head, neck, and shaft, have costal groove that shelters intercostal nerve, artery, and vein
• b: atypical ribs = 1,2,10-12 are unique from each other and all other ribs

• true: 1-7 articulate directly through their costal cartilage with sternum
• false: 8-10 articulate with adjacent costal cartilage
• false floating ribs: 11 and 12 no adjacent cartilage, end at muscle of body wall

• short and broad
• boundary for thoracic inlet
• groove for subclavian artery and vein

• protect internal organs
• attachment of muscles
• assist in breathing

serratus anterior: forms medial wall of axilla, origin from ribs 1-8, inserts in costal surface of scapula such as superior angle, inferior angle, and medial border.

Long thoracic nerve found inside the axilla

rotate scapula, abductor of arm, and elevation above the horizontal plane and respiration

• scapula can't be held down so scapula appears as a wing
• loss of elevation of the arm
• problems with respiration