THE UPPER EXTREMITY. 63 



Outline of the Heart the Valves: 

 Pulmonary valves. 

 Aortic valves. 



Auriculo-ventricular openings. 

 Tricuspid valves. 

 Mitral valves. 

 Relation of the vessels to the wall of the thorax. Aortic arch. 



Innominate artery. Left common carotid. Left subclavian artery. 

 Innominate veins, left, right. 

 Venae cavae : 



Superior. Inferior vena cava. 

 Internal mammary artery. 



Shoulder and Axilla, 1180 to 1184. (1156 to 1160) 

 Surface marks : 



Clavicle. Acromion process. 



Great tuberosity and upper part of shaft of humerus. 

 Coracoid process. Head of humerus. Clavicle. 

 Bicipital groove. 



Characteristic roundness of the shoulder. Deltoid. 

 Pectoralis major. Pectoralis minor. Coraco-brachialis. 

 Axilla. 

 Dissection of the External Thoracic Region and Axilla. 



Make a median incision from the upper to the lower end of the sternum, and three transverse incisions : 

 the first, from the sternum outward along the anterior border of the clavicle, and downward in the 

 anterior median line of the arm; the second, from the lower end of the sternum outward and upward 

 along the lower border of the pectoralis major to the arm, joining the first incision ; the third, from the 

 lower end of the sternum outward and backward to the lower end of the scapula. Beginning at the 

 median line, reflect the skin outward. Expose the superficial fascia of the pectoral region, axilla, and 

 upper third of arm. Expose the superficial nerves and vessels of the thoracic wall. At the upper part 

 of the thorax note the fibres of origin of the platysma. 



The superficial fascia, 308. (311) 

 Platysma myoides, 452. (447) 



Origin. Structure. 

 Superficial nerves : 



Descending branches of cervical nerves, 831. (812) 

 Suprasternal twigs. 

 Supraclavicular nerves. 

 Supra-acrominal branches. 



Anterior cutaneous nerves of the thorax, 845. (826) 

 Lateral cutaneous nerves of the thorax, 845. (825) 



Anterior branches. Posterior branches. 



The superficial arteries of the thoracic region are small branches from : 

 The internal mammary, 549-50; Fig. 344. (540) 



Perforating or anterior perforating branches. 

 Second, third, and fourth perforating. 

 The intercostal arteries, 583 ; Fig. 362. (572) 

 Lateral cutaneous branches. 

 Mammary glandular branches. 

 Lymphatics of the thorax, 695 ; Fig. 399. (680) 

 Parietal lymphatic vessels, 695-6. 

 Superficial parietal lymphatics. 

 Lymphatics of the mammary gland. 

 Superficial parietal glands. Epigastric gland. 



If a female subject, remove the mammary gland and demonstrate its structure. 

 The mammary glands, 1108-9-10; Figs. 657-8. (1084-5-6-7) 

 Female mamma : Mammilla, or nipple. Areola. 

 Secreting organ, structure of: Adipose fossae. Sinus or ampulla. 

 Mammilla. Areola. 

 Variations according to age and functional activity. 



