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Korenkov Topographic Anatomy (1)
| Breast innervation
(Fig. A.4) 1) rr. mammarii laterales from n. cutanei laterales the 2nd – 7th intersotal nerves; 2) rr. mammarii mediales from r. cutanei anteriores the 3rd – 5th intercostal nerves; 3) nn. supraclaviculares from plexus cervicales. The main function of mammae is a synthesis and secretion of milk. The structure and functions of mammae are significantly changing depending on different phases of menstrual cycle, pregnancy and lactation. The changes are determined by functionality of endocrine glands. Among the defects we should mention increase of number of nipples (polythelia), and number of mammae (polymastia). When tissue of mammae loses its elasticity – mastoptosis appears (ptosis of mammae). In case of mastoptosis the plastic surgery is recommended for young women. The men breast augmentation (gynecomastia) is not dangerous for men health, and the mastectomy is indicated for cosmetic reasons only. The breast inflammation (mastitis) is frequently observed among lactating mothers. This disease is associated with infection invading the mammae through scratches and fissures from apostasis on skin surface, and through lactiferous ducts, and hematogenic and lymphatic sinuses as well. According to localization we can distinguish: superficial abscesses, antemammary, abscesses located in the first layer of cellular tissue, abscesses or phlegmons located in the mamma (intramammary), and located behind the mamma 16 (retromammary). The operation is performed under general anaesthesia. The inramammarial abscesses are lancing according to Angerer method. Fibroadenoma is the most frequent type of benign tumour. Fibroadenomae are slowly growing round nodes of firm or a bit elastic texture, with smooth or a bit lumpy surface, and are well-separated from surrounding tissues. Fibroadenomae are considered as precancer conditions, and are subject to operative treatment. The definitive treatment of mammary cancer is radical mastectomy. Under the breast fascia there are muscles mm. pectorales major et minor, which cover chest cage in front, and m. serratus anterior and m. latissimus dorsi, which cover it sideways and from behind. The m. obliquus abdominis externus spring from lateral surface of thoracic cage and covers external surfaces of ribs and intercostal spaces. In its turn intercostal spaces are filled with intercostal muscles, blood vessels and nerves. External intercostal muscles (mm. intercostales externi) fill intercostal spaces between the head of the ribs to the cartilage. Membrana intercostalis externa is their prolongation which looks libe bright aponeurotic plates. The direction of muscle is from top to bottom and back to front. Internal intercostal muscles (mm. intercostales interni) fill intercostal spaces from the lateral part of the chest to the costovertebral angle. The direction of muscles is from bottom to top and from the front to back. Membrana intercostali interna is the prolongation of muscles. There is an intercostal slot between external and internal intercostal muscles bounded with costal sulcus. The slot is filled with adipose tissue where the intercostal neurovascular bundle is located. The elements of neurovascular bundle are 17 located in the following way: there are a vein on the top, a nerve on the bottom, and the artery is located between the vein and nerve (Fig. A.6; Fig. A.7). The chest is supplied with blood by aa. intercostales posteriores from the thoracic part of aorta and by anterior intercostal arteries (aa. intercostales anteriores) from a. thoracica interna. The first and the second intercostal spaces are supplied with blood by the a. intercostalis suprema from truncus costocervicalis and a. thoracica superior from the first жүктеу/скачать 2,76 Mb. Достарыңызбен бөлісу:
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