Anatomy of the terminal branch of the posterior circumflex humeral artery: relevance to the deltopectoral approach to the shoulder.
OBJECTIVE
Despite the expansion of arthroscopic surgery of the shoulder, the open deltopectoral approach is increasingly used for the fixation of fractures and arthroplasty of the shoulder. The anatomy of the terminal branches of the posterior circumflex humeral artery (PCHA) has not been described before. We undertook an investigation to correct this omission.


METHODS
The vascular anatomy encountered during 100 consecutive elective deltopectoral approaches was recorded, and the common variants of the terminal branches of the PCHA are described.


RESULTS
In total, 92 patients (92%) had a terminal branch that crossed the space between the deltoid and the proximal humerus and which was therefore vulnerable to tearing or avulsion during the insertion of the blade of a retractor during the deltopectoral approach to the shoulder. In 75 patients (75%) there was a single vessel, in 16 (16%) a double vessel and in one a triple vessel.


CONCLUSIONS
The relationship of these vessels to the landmark of the tendon of the insertion of pectoralis major into the proximal humerus is described. Damage to these previously undocumented branches can cause persistent bleeding leading to prolonged surgery and post-operative haematoma and infection, as well as poor visualisation during the procedure. Cite this article: Bone Joint J 2016;98-B:1395-8.
Royal Devon and Exeter Hospital, Exeter, Devon, UK.
C D
CD
Smith
Royal Devon and Exeter Hospital, Exeter, Devon, UK.
S J
SJ
Booker
Lister Hospital, Stevenage, Hertfordshire, UK.
H S
HS
Uppal
Royal Devon and Exeter Hospital, Exeter, Devon, UK.
J
J
Kitson
Royal Devon and Exeter Hospital, Exeter, Devon, UK.
T D
TD
Bunker
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000033:anatomy & histology*; D002102:Cadaver; D057645:Deltoid Muscle / Q000098:blood supply*; D005260:Female; D005592:Fracture Fixation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012784:Shoulder Fractures / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult
Anatomy; Deltopectoral; Posterior humeral circumflex artery; Shoulder