PMC6260380_01
a) The longitudinal acromion - olecranon line transecting the transverse line from the axillary fold. Anatomically, the quadrilateral space is 2 cm cranial to this transection point. b) A close up of the two lines and the point (x) localizing the quadrilateral space. c) The ultrasound probe is use.
gr1.jpg
PMC6260380_01_gr1.jpg
fig0005
This point is marked blue in Fig. 1a&b. Using 6-15 Mhz linear ultrasound probe (Fig. 1C) positioned at the postero-medial aspect of the upper arm in the sagittal plane, we first identify the humeral head and neck.
The red circle marks the localized cutaneous branch of the axillary nerve at the skin level (located by ultrasound).
gr2.jpg
PMC6260380_01_gr2.jpg
fig0010
In the current case, the cutaneous branch at the level of the skin is marked as a red circle in Fig. 2.
The cutaneous branch of the axillary nerve is dissected (shown under blue back-ground).
gr3.jpg
PMC6260380_01_gr3.jpg
fig0015
The cutaneous branch is then identified and dissected (Fig. 3).
The cutaneous branch is traced retrograde to the axillary nerve in the quadrilateral space.
gr4.jpg
PMC6260380_01_gr4.jpg
fig0020
Next, the cutaneous branch is followed retrograde to the axillary nerve in the quadrilateral space (Fig. 4).
The divided axillary nerve and the divided triceps nerve are shown under the blue back-ground just prior to coaptation using fibrin glue.
gr5.jpg
PMC6260380_01_gr5.jpg
fig0025
The selected triceps motor branch is transected as distal as possible and is transposed proximally for coaptation to the divided deltoid nerve using fibrin glue (Fig. 5).