ANATOMIC STUDY
... BUT SOMETIMES ...
... the pulse of the subclavian artery is not present…
Therefore the main landmark is missing !
In this case we refer to three bony landmarks:
1. THE MIDDLE POINT OF THE CLAVICLE
2. THE SPINOUS PROCESS OF C7
3. THE STERNOCLAVICULAR JOINT |
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If we connect the midpoint of the clavicle to the spinous process of C7 and to the sternoclaviculal joint we obtain an angle whose bisecting line leads to the brachial plexus (10-11)
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Here we reconstructed the angle on the skeleton
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A cadaver does not have the pulse of the subclavian artery....
We drew the angle and its bisecting line on a cadaver.
A spinal needle was inserted along the bisecting line of the angle and the dissection was then performed.
By lengthening the bisecting line of the angle we obtain a line which reaches the axilla.
It coincides with the "line of anesthesia" by Bazy (12)
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After having removed the skin the fat, the omoioideus muscle and the middle cervical sheat, we can see that the target has been reached! |
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CONCLUSIONS
98 years have passed since Kulenkampff published his technique in 1911; today we still discuss which of the 20 or more techniques practiced over these last years, is the best. All the techniques provide, more or less, the same positive results and the evolution of each individual technique depends on the efforts invested by the diverse practitioners in developing new approaches to avoid the most serious complications. It is true that in the clinical setting the best technique " is the one that one knows best " and that it is also hard to break old habits, but this should not stop anyone from searching always for safer methods or, at least, taking into careful consideration new proposals.
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